Abstract
To investigate the prognostic value of the Pediatric Sequential Organ Failure Assessment (pSOFA) in children with sepsis during hospitalization. Clinical data for children with sepsis or severe sepsis hospitalized in the PICU of the First Affiliated Hospital of Sun Yat-Sen University and that of Shenzhen Children’s Hospital from December 2014 to December 2019 were retrospectively analyzed. Spearman correlation analysis was used to compare correlations among pSOFA, PRISM III, PELOD-2 and P-MODS. Receiver operating characteristic (ROC) curves were plotted to evaluate the efficacy of pSOFA, Pediatric risk of mortality Ⅲ (PRISM III), pediatric logistic organ dysfunction-2 (PELOD-2), and pediatric multiple organ dysfunction score (P-MODS) in predicting risk of death from childhood sepsis based on the area under the ROC curve (AUC). A total of 456 eligible pediatric patients were ultimately enrolled. The median age was 21 months, the mortality rate was 24.1%, and the average length of hospital stay in the PICU was 9 days. Spearman correlation analysis showed the best correlation between pSOFA and PELOD-2 scores (R = 0.554, P < 0.001), followed by PRISM III (R = 0.474, P < 0.001) and P-MODS (R = 0.466, P < 0.001). Based on ROC curve analysis, the AUCs of pSOFA, PRISM III, PELOD-2 and P-MODS for predicting mortality risk were 0.85 (95% CI, 0.81–0.88, P < 0.001), 0.80 (95% CI, 0.76–0.84, P < 0.001), 0.78 (95% CI, 0.74–0.82, P < 0.001) and 0.72 (95% CI, 0.67–0.76, P < 0.001), respectively. The best cutoff value of pSOFA for predicting in-hospital death in children with sepsis was > 7 (sensitivity 88.07%, specificity 64.71%). Moreover, the Hosmer–Lemeshow goodness-of-fit test indicated better calibration between predicted mortality and observed mortality for pSOFA PRISM III and PELOD-2 (pSOFA: P=0.366;PRISM III༚P༝0.189༛PELOD-2༚P༝0.121), whereas P-MODS showed poor calibration (P<0.001). The AUC value of pSOFA was the highest, and its is superior to PRISM III and PELOD-2 scores at predicting the severity and prognosis of sepsis in children. pSOFA showed the best calibration between predicted mortality and observed mortality in childhood sepsis, followed by PRISM III and PELOD-2. Therefore, pSOFA has important guiding value in predicting risk of death from sepsis in children.