Development and Validation of a Disease Severity Scoring Model for Pediatric Sepsis
Background: Multiple severity scoring systems have been devised and evaluated in adult sepsis, but a simplified scoring model for pediatric sepsis has not yet been developed. This study aimed to develop and validate a new scoring model to stratify the severity of pediatric sepsis, thus assisting the treatment of sepsis in children.
Methods: Data from 634 consecutive patients who presented with sepsis at Children’s hospital of Hunan province in China in 2011-2013 were analyzed, with 476 patients placed in training group and 158 patients in validation group. Stepwise discriminant analysis was used to develop the accurate discriminate model. A simplified scoring model was generated using weightings defined by the discriminate coefficients. The discriminant ability of the model was tested by receiver operating characteristic curves (ROC).
Results: The discriminant analysis showed that prothrombin time, D-dimer, total bilirubin, serum total protein, uric acid, PaO2/FiO2 ratio, myoglobin were associated with severity of sepsis. These seven variables were assigned with values of 4, 3, 3, 4, 3, 3, 3 respectively based on the standardized discriminant coefficients. Patients with higher scores had higher risk of severe sepsis. The areas under ROC (AROC) were 0.836 for accurate discriminate model, and 0.825 for simplified scoring model in validation group.
Conclusions: The proposed disease severity scoring model for pediatric sepsis showed adequate discriminatory capacity and sufficient accuracy, which has important clinical significance in evaluating the severity of pediatric sepsis and predicting its progress.
Fry DE (2012). Sepsis, systemic inflammatory re¬sponse, and multiple organ dysfunction: the mys¬tery con-tinues. Am Surg, 78(1): 1-8.
Booker E (2011). Sepsis, severe sepsis, and septic shock: current evidence for emergency depart¬ment man-agement. Emerg Med Pract, 13(5): 1-22, 22-23.
Jawad I, Luksic I, Rafnsson SB (2012). Assessing avail¬a-ble information on the burden of sepsis: global es-timates of incidence, prevalence and mortality. J Glob Health, 2(1): 010404.
Wong HR, Weiss SL, Giuliano JJ, Wainwright MS, Cvija¬novich NZ, Thomas NJ, et al. (2014). Test¬ing the prognostic accuracy of the updated pedi¬at¬ric sepsis biomarker risk model. PLoS One, 9(1): e86242.
Wheeler DS, Jeffries HE, Zimmerman JJ, Wong HR, Carcillo JA (2011). Sepsis in the pediatric car¬diac in-tensive care unit. World J Pediatr Congenit Heart Surg, 2(3): 393-399.
Wiens MO, Kumbakumba E, Kissoon N, An¬sermino JM, Ndamira A, Larson CP (2012). Pe¬diatric sep¬sis in the developing world: chal¬lenges in defining sep-sis and issues in post-dis¬charge mortality. Clin Epi-demiol, 4: 319-325.
Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG et al. (2010). Global, regional, and na-tional causes of child mortality in 2008: a sys¬tem¬atic analysis. Lancet, 375(9730): 1969-1987.
Riley C, Wheeler DS (2012). Prevention of sepsis in chil-dren: a new paradigm for public policy. Crit Care Res Pract, 2012: 437139.
Edmond K, Zaidi A (2010). New approaches to pre-venting, diagnosing, and treating neonatal sepsis. PLoS Med, 7(3): e1000213.
Wong HR, Weiss SL, Giuliano JJ, Wainwright MS, Cvija¬novich NZ, Thomas NJ, et al. (2014). The tem¬poral version of the pediatric sepsis bi¬omarker risk model. PLoS One, 9(3): e92121.
Vincent J, de Carvalho FB (2010). Severity of illness. Semin Respir Crit Care Med, 31(1): 31-38.
Howell MD, Talmor D, Schuetz P, Hunziker S, Jones AE, Shapiro NI (2011). Proof of princi¬ple: the pre-disposition, infection, response, or¬gan fail¬ure sepsis staging system. Crit Care Med, 39(2): 322-327.
Oda S, Hirasawa H, Sugai T, et al (2006). Compari¬son of sepsis-related Organ Failure Assess¬ment(SOFA) score and CIS(cellular injury score) for scoring of severity for patients with multiple or¬gan dysfuction syndrome(MODS). Intensive Care Med, 26(12): 1786-1793.
De Leon AL, Romero-Gutierrez G, Valenzuela CA, Gonzalez-Bravo FE (2005). Simplified PRISM III score and outcome in the pediatric intensive care unit. Pediatr Int, 47(1): 80-83.
Le Gall J (2001). Modeling the severity of illness of ICU patients. Eur J Intern Med, 12(4): 321.
Moreno RP, Diogo AC, Afonso S (2009). Risk strat-ifica¬tion in severe sepsis: organ failure scores or PI-RO? In Management of sepsis: the PIRO Approach. Eds, Jordi Rello, Emilio DiazandAlejandro Ro¬dri¬guez. New York: Spinger,pp.1-9.
Goldstein B, Giroir B, Randolph A (2005). Interna¬tional pediatric sepsis consensus conference: def¬ini¬tions for sepsis and organ dysfunction in pedi¬at¬rics. Pedi-atr Crit Care Med, 6(1): 2-8.
Levy MM, Fink MP, Marshall JC, et al (2003). 2001 SCCM/ESICM/ACCP/ATS/SIS interna¬tional sep¬sis definitions conference. Crit Care Med, 31(4): 1250-1256.
Haeusler GM, Slavin MA (2012). Complications of sep-sis: the role of risk prediction rules, bi¬omarkers and host genetics. Expert Rev Anti In¬fect Ther, 10(7): 733-735.
Anderson IB, Sudhakar S, Keenan CR, Srinivasan M (2013). The elusive SIRS diagnosis. J Gen In¬tern Med, 28(3): 470-474.
Remington JS, Klein JO, Wilson CB, et al (2006). In¬fec-tious diseases of the fetus and newborn in¬fant. N Engl J Med, 355: 531-532.
Tan H, Ping W, Yang T, Li S, Liu A, Zhou J, et al. (2007). The synthetic evaluation model for anal¬y¬sis of flooding hazards. Eur J Public Health, 17(2): 206-210.
Chen Z, Li Y, Tong Y, Gao Q, Mao X, Zhang W, et al. (2016). Stepwise discriminant function analy¬sis for rapid identification of acute pro¬myelocytic leu¬kemia from acute myeloid leuke¬mia with mul¬tipa¬rameter flow cytometry. Int J Hematol, 103(3): 306-315.
Huang P, Tan H, Liu A, Feng S, Chen M (2010). Pre-dic¬tion of posttraumatic stress distorder among adults in flood district. BMC Public Health, 10(1): 207.
Pierrakos C, Vincent JL (2010). Sepsis biomarkers: a re-view. Crit Care, 14(1): R15.
Standage SW, Wong HR (2011). Biomarkers for pe¬diat-ric sepsis and septic shock. Expert Rev Anti In¬fect Ther, 9(1): 71-79.
Meem M, Modak JK, Mortuza R, Morshed M, Is¬lam MS, Saha SK (2011). Biomarkers for diag¬nosis of neonatal infections: A systematic anal¬ysis of their potential as a point-of-care diagnos¬tics. J Glob Health, 1(2): 201-209.
Lee SH, Chan RC, Wu JY, Chen HW, Chang SS, Lee CC (2013). Diagnostic value of procalci¬tonin for bacterial infection in elderly patients - a systemic re-view and meta-analysis. Int J Clin Pract, 67(12): 1350-1357.
Tian Y, Tao T, Zhu J, Zou Y, Wang J, Li J, et al. (2013). Soluble tumor necrosis factor related apopto¬sis in-ducing ligand level as a predictor of se¬verity of sep-sis and the risk of mortality in sep¬tic patients. PLoS One, 8(12): e82204.
Yang SK, Xiao L, Zhang H, Xu XX, Song PA, Liu FY, et al. (2014). Significance of serum procal¬ci¬tonin as biomarker for detection of bacterial per¬ito¬nitis: a systematic review and meta-analy¬sis. BMC Infect Dis, 14: 452.
Ratzinger F, Schuardt M, Eichbichler K, Tsirkinidou I, Bauer M, Haslacher H, et al. (2013). Utility of sep¬sis biomarkers and the in¬fection probability score to discriminate sepsis and systemic inflam¬ma¬tory re-sponse syndrome in standard care pa¬tients. PLoS One, 8(12): e82946.
Shapiro NI, Wolfe RE, Moore RB, Smith E, Bur¬dick E, Bates DW (2003). Mortality in Emer¬gency De-partment Sepsis (MEDS) score: a pro¬spec¬tively de-rived and validated clinical predic¬tion rule. Crit Care Med, 31(3): 670-675.
Carpenter CR, Keim SM, Upadhye S, Nguyen HB et al (2009). Risk stratification of the potentially sep¬tic pa-tient in the emergency department: the Mortal¬ity in the Emergency Department Sepsis (MEDS) score. J Emerg Med, 37(3): 319-327.
Jones AE,Saak K,Kline JA (2008). Performance of the mortality in emergency department sepsis score for predicting hospital mortality among pa¬tients with severe sepsis and septic shock. Am J Emerg Med, 26(6): 689-692.
Alberti C, Brun-Buisson C, Chevret S, Antonelli M, Goodman SV, Martin C, et al. (2005). Systemic in-flammatory response and progression to se¬vere sepsis in critically ill infected patients. Am J Respir Crit Care Med, 171(5): 461-468.
Okascharoen C, Sirinavin S, Thakkinstian A, Kita¬ya-porn D, Supapanachart S (2005). A bedside pre¬dic-tion-scoring model for late-onset neona¬tal sep¬sis. J Perinatol, 25(12): 778-783.
Wong HR, Salisbury S, Xiao Q, Cvijanovich NZ, Hall M, Allen GL, et al. (2012). The pediatric sep¬sis bi-omarker risk model. Crit Care, 16(5): R174.
Costa GA, Delgado AF, Ferraro A, Okay TS (2010). Ap¬plication of the pediatric risk of mortality (PRISM) score and determination of mortality risk factors in a tertiary pediatric intensive care unit. Clinics (Sao Paulo), 65(11): 1087-1092.
Ghanem-Zoubi NO, Vardi M, Laor A, Weber G, Bit-terman H (2011). Assessment of disease-se¬ver¬ity scoring systems for patients with sepsis in gen¬eral internal medicine departments. Crit Care, 15(2): R95.
|Issue||Vol 45 No 7 (2016)|
|Sepsis Disease severity scoring model Pediatrics Discriminant analysis|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|