New PELOD-2 cut-off score for predicting death in children with sepsis

Main Article Content

Ni Made Rini Suari
Abdul Latief
Antonius H. Pudjiadi

Abstract

Background According to the most recent Sepsis-3 Consensus, the definition of sepsis is life-threatening organ dysfunction caused by dysregulated immune system against infection. Currently, one of the most commonly used prognostic scoring system is pediatric logistic organ damage-2 (PELOD-2) score.


Objective To determine and validate the pediatric logistic organ dysfunction-2 (PELOD-2) cut-off score to predict mortality in pediatric sepsis patients.


Methods A prospective cohort study was conducted in the intensive care units of Cipto Mangunkusumo Hospital, Jakarta. We assessed subjects with PELOD-2 and calculated the predicted death rate (PDR) using SFAR software. The Hosmer-Lemeshow goodness-of-fit test was used to evaluate calibration and the area under the curve (AUC) of the receiver operating characteristic curve (ROC) to estimate discrimination.


Results Of 2,735 children admitted to the emergency department, 52 met the inclusion criteria. Patients had various types of organ dysfunction: 53.8% respiratory, 28.8% neurological, 15.4% cardiovascular, 1.9% hematological. The mortality rate in this study was 38.5%. Mean PELOD-2 score was higher in patients who died than in those who survived [13.9 (SD 4.564) vs. 7.59 (SD 3.025), respectively, P=0.000]. The discrimination of PELOD-2 score with the lactate component had an AUC of 85.5% (95%CI 74.5 to 96.5), while PELOD-2 without lactate had an AUC of 85.4% (95%CI 74.5 to 96.3%). We propose a new PELOD-2 cut-off score to predict organ dysfunction and death of 10, with 75% sensitivity, 72% specificity, 62.5% PPV, and 82% NPV. PELOD-2 score > 10 had a moderate, statistically significant correlation to mortality (r=0.599; P<0.001).


Conclusion A PELOD-2 score > 10 is valid for predicting life-threatening organ dysfunction in pediatric patients with sepsis.

Article Details

How to Cite
1.
Suari NM, Latief A, Pudjiadi A. New PELOD-2 cut-off score for predicting death in children with sepsis. PI [Internet]. 9Feb.2021 [cited 7Mar.2021];61(1). Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2441
Section
Emergency & Pediatric Intensive Care
Received 2020-06-26
Accepted 2021-02-01
Published 2021-02-09

References

1. Leclerc F, Leteurtre S, Duhamel A, Grandbastien B, Proulx F, Martinot A, et al. Cumulative influence of organ dysfunctions and septic state on mortality of critically ill children. Am J Respir Crit Care Med. 2005;171:348–53. DOI: 10.1164/rccm.200405-630OC.
2. Priyatiningsih DR. Karakteristik sepsis di pediatric intensive care unit RSUPN dr. Cipto Mangunkusumo. [dissertation]. [Jakarta]: Fakultas Kedokteran Universitas Indonesia; 2016.
3. Wilkinson JD, Pollack MM, Ruttimann VE, Glass NL, Yeh TS. Outcome of pediatric patients with multiple organ system failure. Crit Care Med. 1986;14:271–4. DOI: 10.1097/00003246-198604000-00002.
4 . Proulx F, Fayon M, Farrell CA, Lacroix J, Gauthier M. Epidemiology of sepsis and multiple organ dysfunction syndrome in children. Chest. 1996;109:1033–7. DOI: 10.1378/chest.109.4.1033
5. Proulx F, Leteurtre S, Joyal JS, Jouvet P. Multiple organ dysfunction syndrome. Pediatr Crit Care Med. 2014:457-73. DOI: 10.1097/PCC.0b013e31819370a9
6. Wilkinson JD, Pollack MM, Glass NL, Kanter RK, Kat RW, Steinhart CM. Mortality associated with multiple organ system failure and sepsis in pediatric intensive care unit. J Pediatr. 1987;111;324-8. DOI: 10.1016/s0022-3476(87)80448-1.
7. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee, American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101:1644 – 55. DOI: 10.1378/chest.101.6.1644.
8. Zhao H, Heard SO, Mullen MT, Crawford S, Goldberg RJ, Frendl G, et al. An evaluation of the diagnostic accuracy of the 1991 American College of Chest Physicians/Society of Critical Care Medicine and the 2001 Society of Critical Care Medicine/European Society of Intensive Care Medicine/American College of Chest Physicians/American Thoracic Society/Surgical Infection Society sepsis definition. Crit Care Med. 2012;40:1700-6. DOI: 10.1097/CCM.0b013e318246b83a.
9. Goldstein B, Giroir B, Randolph A, International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6:2–8. DOI: 10.1097/01.PCC.0000149131.72248.E6.
10. Singer M, Deutschman CS, Seymour CW, Shankar-ri M, Annane D, Bauer M, et al. The Third International Consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801-10. DOI: 10.1001/jama.2016.0287.
11. Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of clinical criteria for sepsis: for the Third International Consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:762-74. DOI: 10.1001/jama.2016.0288.
12. Leteurtre S, Duhamel A, Salleron J, Grandbastien B, Lacroix J, Leclerc F. PELOD-2. Critical Care Medicine. 2013;41(7):1761-1773. DOI : 10.1097/CCM.ObOI 3e31828a2bbd
13. Schlapbach L, Straney L, Bellomo R, MacLaren G, Pilcher D. Prognostic accuracy of age-adapted SOFA, SIRS, PELOD-2, and qSOFA for in-hospital mortality among children with suspected infection admitted to the intensive care unit. Intensive Care Medicine. 2017;44(2):179-188. DOI: 10.1007/s00134-017-5021-8.
14. World Health Organization Technical Report Series 854. Physical status: the use and interpretation of anthropometry. Geneva: WHO Expert Committee; 1995. p. 161-262.
15. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, et al. 2000 CDC growth charts for the United States: methods and development. National Center for Health Statistics. Vital Health Stat. 2002;11:1-190.
16. Waterlow JC. Classification and definition of protein-calorie malnutrition. Br Med J. 1972;3:566-9.
17. Société Francaisé d’Anesthésie et de Réanimation (SFAR). Scoring systems for ICU and surgical patients: PELOD Score (Pediatric Logistic Organ Dysfunction). [cited 2017 July 3]. Available from: https://sfar.org/scores2/pelod2.php.
18. Leteurtre S, Duhamel A, Grandbastien B, Proulx F, Cotting J, Gottesman R, et al. Daily estimation of the severity of multiple organ dysfunction syndrome in critically ill children. CMAJ. 2010;182:1181-7. DOI: 10.1503/cmaj.081715
19. Leteurtre S, Duhamel A, Grandbastien B, Lacroix J, Leclerc F. Paediatric logistic organ dysfunction (PELOD) score [letter]. Lancet. 2006;367:897. DOI: 10.1016/S0140-6736(06)68371-2.
20. Angele MK, Pratschke S, Hubbard WJ, Chaudry IH. Gender differences in sepsis: cardiovascular and immunological aspects. Virulence. 2014;5:12-9. DOI: 10.4161/viru.26982.
21. Wynn J, Cornell TT, Wong HR, Shanley TP, Wheeler DS. The host response to sepsis and developmental impact. Pediatrics. 2010;125:1031-41. DOI: 10.1542/peds.2009-3301.
22. Keusch GT. The history of nutrition: malnutrition, infection and immunity. J Nutr. 2003;133:336S-40S. DOI: 10.1093/jn/133.1.336S.
23. World Health Organization Global Health Observatory. Causes of child mortality. 2013. [cited 2017 July 3]. Available from : www.who.int/gho/child_health/mortality/causes/en/.
24. Garcia PC, Eulmesekian P, Branco RG, Perez A, Sffogia A, Oliveo L, et al. External validation of the paediatric logistic organ dysfunction score. Intensive Care Med. 2010;36:116-22. DOI: 10.1007/s00134-009-1489-1.
25. Scott HF, Brou L, Deakyne SJ, Kempe A, Fairclough DL, Bajaj L. Association between early lactate levels and 30-day mortality in clinically suspected sepsis in children. JAMA Pediatr. 2017;171:1-7. DOI: 10.1001/jamapediatrics.2016.3681.