Day-1 PELOD-2 and day-1 "quick" PELOD-2 scores in children with sepsis in the PICU

Zhong, Mianling; Huang, Yuge; Li, Tufeng; Xiong, Lu; Lin, Ting; Li, Miaofen; He, Dongqiang

doi:10.1016/j.jped.2019.07.007

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Original articles • J. Pediatr. (Rio J.) 96 (5) • Sep-Oct 2020 • https://doi.org/10.1016/j.jped.2019.07.007 copy

Day-1 PELOD-2 and day-1 "quick" PELOD-2 scores in children with sepsis in the PICU^☆ ☆ Please cite this article as: Zhong M, Huang Y, Li T, Xiong L, Lin T, Li M, et al. Day-1 PELOD-2 and day-1 "quick" PELOD-2 scores in children with sepsis in the PICU. J Pediatr (Rio J). 2020;96:660-5.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

This study aimed to evaluate the predictive validity of the day-1 PELOD-2 and day-1 "quick" PELOD-2 (qPELOD-2) scores for in-hospital mortality in children with sepsis in a pediatric intensive care unit (PICU) of a developing country.

Methods:

The data of 516 children diagnosed as sepsis were retrospectively analyzed. The children were divided into survival group and non-survival group, according to the clinical outcome 28 days after admission. Day-1 PELOD-2, day-1 qPELOD-2, pediatric SOFA (pSOFA), and P-MODS were collected and scored. Receiver operating characteristic (ROC) curves were plotted, and the efficiency of the day-1 PELOD-2, day-1 qPELOD-2 score, pSOFA, and P-MODS for predicting death were evaluated by the area under the ROC curve (AUC).

Results:

The day-1 PELOD-2 score, day-1 qPELOD-2 score, pSOFA, and P-MODS in the non-survivor group were significantly higher than those in the survivor group. ROC curve analysis showed that the AUCs of the day-1 PELOD-2 score, day-1 qPELOD-2 score, pSOFA, and P-MODS for predicting the prognosis of children with sepsis in the PICU were 0.916, 0.802, 0.937, and 0.761, respectively (all p < 0.05).

Conclusions:

Both the day-1 PELOD-2 score and day-1 qPELOD-2 score were effective and able to assess the prognosis of children with sepsis in a PICU of a developing country. Additionally, the day-1 PELOD-2 score was superior to the day-1 qPELOD-2 score. Further studies are needed to verify the usefulness of the day-1 qPELOD-2 score, particularly outside of the PICU.

KEYWORDS
PELOD-2 score; "Quick" PELOD-2 score; Sepsis; Prognosis; Children

Characteristic	Survivors (n = 488)	Non-survivors (n = 28)	p-value
Male, No. (%)	311 (63.7)	16 (57.1)	0.482
Age, median (IQR), Months Site of infection, No. (%)	8 (2-36)	12 (3-36)	0.479
Respiratory system	280 (57.4)	11 (39.3)
Nervous system	72 (14.8)	6 (21.4)
Digestive system	43 (8.8)	2 (7.1)
Blood	6 (1.2)	0
Urinary tract	13 (2.6)	0
Other	74 (15.2)	9 (32.1)
Sepsis classification			≤0.001
Sepsis, No. (%)	238 (49)	0 (0)
Severe sepsis, No. (%)	242 (50)	20 (71)
Septic shock No. (%)	8 (1)	8 (29)
Required mechanical Ventilation, No. (%)	69 (14.1)	22 (78.6)	≤0.001
Required vasoactive Infusion on day 1, No. (%) Auxiliary examination	8 (1.6)	6 (21.4)	≤0.001
Glasgow scale [score, median (IQR)]	13 (11-13)	7 (4-9)	≤0.001
PaO₂ [mmHg, median (IQR)]	97 (80-115)	104 (62-136)	0.887
PaCO₂ [mmHg, median (IQR)]	30.7 (25.6-35.0)	27.2 (22.6-38.58)	0.536
Lactic acid concentration [umol/L, median (IQR)]	1.2 (0.8-2.0)	2.9 (1.1-10.3)	≤0.001
Creatinine values [umol/L, median (IQR)]	22.6 (17.0-31.0)	30.0 (16.5-55.3)	0.051
Blood urea nitrogen [mmol/L, median (IQR)]	3.2 (2.4-4.3)	4.4 (2.8-6.7)	0.006
Total bilirubin concentration [umol/L, median (IQR)]	6.4 (4.6-10.3)	8.7 (5.9, 19)	0.04
Fibrinogen concentration [g/L, median (IQR)]	2.7 (2.0-3.5)	1.8 (1.2-3.0)	0.001
White blood cell values [*109/L, median (IQR)]	13.4 (9.0, 19.0)	15.4 (9.5, 20.6)	0.407
Platelet values [*109/L, median (IQR)]	323 (240, 427)	292 (211, 388)	0.132
Scores on day 1 [score, median (IQR)]
PELOD-2	0 (0-2)	6.5 (4-8)	≤0.001
qPELOD-2	0 (0-1)	1 (1-2)	≤0.001
pSOFA	3 (2-4)	7.5 (6-11)	≤0.001
P-MODS	1 (1-2)	3 (2-6)	≤0.001
Outcomes, median (IQR) Duration of ventilatory support, d PICU LOS ≥ 72 h (%) PICU LOS, days	0 (0-0) 251 (51.4) 1 (1-8)	2 (1-5) 16 (57.1) 3 (2-6)	≤0.001 0.698 0.686
Hospital LOS, days	9 (6-15)	3 (2-6)	≤0.001

Scoring system	AUC	95% CI	Cutoff	SE (%)	SP (%)	+PV (%)	-PV (%)	Z-score	p-value
PELOD-2	0.916	0.888-0.938	>2	89	81	21	99	14.228	≤0.001
qPELOD-2	0.802	0.765-0.836	>0	89	62	12	99	7.905	≤0.001
pSOFA	0.937	0.913-0.957	>5	86	88	29	99	26.436	≤0.001
P-MODS	0.761	0.722-0.798	>2	64	82	17	98	4.688	≤0.001

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E-mail: jped@jped.com.br

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[1] * Corresponding author. E-mail: Corresponding author. gdmcerke@hotmail.com (Y. Huang).

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Day-1 PELOD-2 and day-1 "quick" PELOD-2 scores in children with sepsis in the PICU☆ ☆ Please cite this article as: Zhong M, Huang Y, Li T, Xiong L, Lin T, Li M, et al. Day-1 PELOD-2 and day-1 "quick" PELOD-2 scores in children with sepsis in the PICU. J Pediatr (Rio J). 2020;96:660-5.

Abstract

Objectives:

Methods:

Results:

Conclusions:

Day-1 PELOD-2 and day-1 "quick" PELOD-2 scores in children with sepsis in the PICU^☆ ☆ Please cite this article as: Zhong M, Huang Y, Li T, Xiong L, Lin T, Li M, et al. Day-1 PELOD-2 and day-1 "quick" PELOD-2 scores in children with sepsis in the PICU. J Pediatr (Rio J). 2020;96:660-5.