Assessing the prognostic accuracy of the PSS, pSOFA, and SIRS for in-hospital mortality in children with suspected infection in non-ICU settings: a multicenter retrospective study

IF 4.3 2区医学 Q1 INFECTIOUS DISEASES

International Journal of Infectious Diseases Pub Date : 2025-09-01 DOI:10.1016/j.ijid.2025.108044

Ruiying Liu , Xuanwen Ru , Zihao Yang , Tiewei Li , Junmei Yang , Yang Liu , Xiaoyu Cui , Jing Wu , Ruijie Yu , Zhan Ma , Baoyu Yuan , Feng Cheng , Suhong Huang , Caizhi Huang , Cong Zhang , Hongbing Chen , Xun Zhou , Xiaowei Zhang , JingRan Wang , Xin Lv , Qing Ye

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引用次数: 0

Abstract

Objectives

To systematically compare the predictive accuracy of the Phoenix Sepsis Score (PSS), the Pediatric Sequential Organ Failure Assessment (pSOFA), and systemic inflammatory response syndrome (SIRS) in assessing in-hospital mortality risk among pediatric sepsis patients in non-intensive care unit (non-ICU) wards, thereby providing evidence-based support for clinical risk stratification.

Design

This study employed a multicenter retrospective cohort design, enrolling non-ICU pediatric patients with suspected infections (excluding preterm infants and neonates hospitalized immediately after birth), to construct an overall cohort and a neonatology subgroup cohort. Clinical parameters were collected through a data acquisition system, with parallel calculations of PSS, pSOFA, and SIRS scores. The primary endpoint was in-hospital mortality. Receiver operating characteristic (ROC) curves were constructed via R language version 4.3.1, and the discriminatory performance of each scoring system was evaluated via the area under the ROC curve (AUROC).

Results

From January 2023 to September 2024, 965 non-ICU pediatric patients with infections were enrolled from 13 medical centers (overall cohort mortality: 1.1%, 11/965; neonatology cohort: 193 cases, mortality: 4.1%, 8/193). In the overall cohort, all 11 patients experienced deterioration on the ward and were subsequently transferred to the pediatric intensive care unit (PICU) in accordance with each hospital's protocol; eight of them died from sepsis, and three from septic shock. After multivariate adjustment, the AUROC value of the PSS score in the overall cohort was 0.756 (99% CI: 0.731-0.780), representing a 3.6% improvement over the SIRS criteria (0.730, 99% CI: 0.543-0.873) but lower than the pSOFA score (0.845, 99% CI: 0.568-0.966). In the neonatology cohort, the AUROC value of the PSS score was 0.764 (99% CI: 0.478-0.927), comparable to that of the SIRS criteria (0.757, 99% CI: 0.475-0.905) but still lower than that of the pSOFA score (0.819, 99% CI: 0.533-0.983). No statistically significant differences were observed among the three scoring systems (P > 0.01).

Conclusions

These findings suggest that the PSS score does not demonstrate superior predictive value compared with traditional assessment tools in non-ICU clinical scenarios.

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评估PSS、pSOFA和SIRS对非icu环境中疑似感染儿童住院死亡率的预测准确性：一项多中心回顾性研究

目的：系统比较Phoenix脓毒症评分（PSS）、小儿顺序器官衰竭评估（pSOFA）和全身性炎症反应综合征（SIRS）在评估非icu病房儿科脓毒症患者住院死亡风险中的预测准确性，为临床风险分层提供循证支持。设计：本研究采用多中心回顾性队列设计，纳入疑似感染的非icu儿科患者（不包括早产儿和出生后立即住院的新生儿），构建总队列和新生儿亚组队列。通过数据采集系统收集临床参数，并并行计算PSS、pSOFA和SIRS评分。主要终点是住院死亡率。采用R语言4.3.1版构建受试者工作特征（ROC）曲线，通过ROC曲线下面积（AUROC）评价各评分系统的区分效果。结果：2023年1月至2024年9月，共纳入13个医疗中心的965例非icu感染患儿（总队列死亡率：1.1%,11/965；新生儿亚组：193例，死亡率：4.1%,8/193）。在整个队列中，所有11名患者在病房出现病情恶化，随后根据每家医院的方案转至PICU；其中8人死于败血症，3人死于感染性休克。多因素调整后，整个队列中PSS评分的AUROC值为0.756 (99% CI: 0.731-0.780)，比SIRS标准（0.730,99% CI: 0.543-0.873）提高了3.6%，但低于pSOFA评分（0.845,99% CI: 0.568-0.966）。在新生儿亚组中，PSS评分的AUROC值为0.764 (99% CI: 0.478 ~ 0.927)，与SIRS标准（0.757,99% CI: 0.475 ~ 0.905）相当，但仍低于pSOFA评分（0.819,99% CI: 0.533 ~ 0.983）。三种评分系统间比较差异无统计学意义（P < 0.05）。结论：这些研究结果表明，在非icu临床情况下，与传统评估工具相比，PSS评分并没有表现出优越的预测价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Infectious Diseases 医学-传染病学

CiteScore

18.90

自引率

2.40%

发文量

1020

审稿时长

30 days

期刊介绍： International Journal of Infectious Diseases (IJID) Publisher: International Society for Infectious Diseases Publication Frequency: Monthly Type: Peer-reviewed, Open Access Scope: Publishes original clinical and laboratory-based research. Reports clinical trials, reviews, and some case reports. Focuses on epidemiology, clinical diagnosis, treatment, and control of infectious diseases. Emphasizes diseases common in under-resourced countries.