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IF 4 2区医学 Q1 CRITICAL CARE MEDICINE

Pediatric Critical Care Medicine Pub Date : 2025-02-01 Epub Date: 2025-02-06 DOI:10.1097/PCC.0000000000003683

Roelie M Wösten-van Asperen, Hannah M la Roi-Teeuw, Wim J E Tissing, Iolanda Jordan, Christian Dohna-Schwake, Gabriella Bottari, John Pappachan, Roman Crazzolara, Angela Amigoni, Agnieszka Mizia-Malarz, Andrea Moscatelli, María Sánchez-Martín, Jef Willems, Luregn J Schlapbach

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引用次数: 0

摘要

目的：儿科败血症定义工作组开发并验证了一种新的器官功能障碍评分，即凤凰城败血症评分（PSS），作为预测疑似或确诊感染患儿死亡率的指标。与之前的评分相比，PSS 的表现有所改善。然而，该标准是在普通儿科人群中得出的，其中只有 10%的人患有癌症。鉴于患有败血症的儿科癌症患者的死亡率高于患有败血症的非癌症患者，我们旨在对患有癌症和败血症的 PICU 患者的 PSS 进行评估：设计：回顾性多中心队列研究：背景：欧洲的 12 个 PICU：每个PICU确定年龄在18岁或以下、患有基础恶性肿瘤、疑似或已证实患有脓毒症、在2018年1月1日至2020年1月1日期间入院的患者：无：计算PSS和其他三个评分，包括Phoenix-8、儿科逻辑器官功能障碍-2（PELOD-2）评分和儿科序贯器官衰竭评估（pSOFA）评分，以进行比较。主要结果是 90 天全因死亡率。我们使用接收者操作特征曲线下面积（AUROC）和精确度-召回曲线下面积（AUPRC）分析比较了评分性能。在 383 名确诊或疑似败血症患者中，90 天死亡率为 19.3%（74/383）。我们未能发现特定评分与 90 天死亡率之间存在关联。各评分的 AUROC 平均值（95% CI）为PSS 0.66 (0.59-0.72)、Phoenix-8 0.65 (0.58-0.72)、PELOD-2 0.64 (0.57-0.71)和 pSOFA 0.67 (0.60-0.74)，各评分的 AUPRC 平均值分别为PSS为0.32（0.23-0.42），Phoenix-8为0.32（0.23-0.42），PELOD-2为0.32（0.22-0.43），pSOFA为0.36（0.26-0.46）。PICU死亡率或与败血症相关的PICU死亡率也得到了类似的结果：与普通PICU人群相反，我们在2018-2020年欧洲PICU肿瘤疑似或确诊败血症数据集中对PSS进行的回顾性测试未能发现与死亡率相关的性能改善。这一独特的患者群体值得开发专门反映这些患者器官功能障碍和死亡率数据的器官功能障碍评分，并需要在未来的研究中进行前瞻性验证。

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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The Phoenix Sepsis Score in Pediatric Oncology Patients With Sepsis at PICU Admission: Test of Performance in a European Multicenter Cohort, 2018-2020.

Objectives: The Pediatric Sepsis Definition Task Force developed and validated a new organ dysfunction score, the Phoenix Sepsis Score (PSS), as a predictor of mortality in children with suspected or confirmed infection. The PSS showed improved performance compared with prior scores. However, the criteria were derived in a general pediatric population, in which only 10% had cancer. Given that pediatric cancer patients with sepsis have higher mortality compared with noncancer patients with sepsis, we aimed to assess the PSS in PICU patients with cancer and sepsis.

Design: Retrospective multicenter cohort study.

Setting: Twelve PICUs across Europe.

Patients: Each PICU identified patients 18 years young or younger, with underlying malignancy and suspected or proven sepsis, and admission between January 1, 2018, and January 1, 2020.

Interventions: None.

Measurements and main results: The PSS and three other scores, including Phoenix-8, Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score, and pediatric Sequential Organ Failure Assessment (pSOFA) score, were calculated for comparison. The primary outcome was 90-day all-cause mortality. We compared score performance using area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC) analyses. Among 383 patients with proven or suspected sepsis, 90-day mortality was 19.3% (74/383). We failed to identify an association between a particular score and performance for 90-day mortality. The mean (95% CI) values for the AUROC of each score was: PSS 0.66 (0.59-0.72), Phoenix-8 0.65 (0.58-0.72), PELOD-2 0.64 (0.57-0.71), and pSOFA 0.67 (0.60-0.74) and for the AUPRC of each score: PSS 0.32 (0.23-0.42), Phoenix-8 0.32 (0.23-0.42), PELOD-2 0.32 (0.22-0.43), and pSOFA 0.36 (0.26-0.46). Similar results were obtained for PICU mortality or sepsis-related PICU mortality.

Conclusions: Contrary to the general PICU population, our retrospective test of the PSS in a PICU oncology dataset with suspected or proved sepsis from European PICUs, 2018-2020, failed to identify improved performance in association with mortality. This unique patient population deserves development of organ dysfunction scores that reflect organ dysfunction and mortality data specifically from these patients and will require prospective validation in future studies.

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来源期刊

Pediatric Critical Care Medicine 医学-危重病医学

CiteScore

7.40

自引率

14.60%

发文量

991

审稿时长

3-8 weeks

期刊介绍： Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.