Evaluation of modified pediatric sepsis-induced coagulopathy score in pediatric septic shock

Background

Sepsis-induced coagulopathy (SIC) is highly prevalent and plays an important role in the pathophysiology of sepsis. However, validated assessment tools for pediatric SIC under the 2024 pediatric sepsis criteria remain lacking. This study aimed to develop and validate a modified pediatric SIC (pSIC) score based on the Phoenix Sepsis Score (PSS) and evaluate its diagnostic and prognostic utility in children.

Methods

This retrospective study enrolled pediatric patients with septic shock admitted to the Pediatric Intensive Care Unit of Children's Hospital of Chongqing Medical University between May 2015 and August 2023. A modified pSIC score was developed by replacing the Sequential Organ Failure Assessment (SOFA) score with the PSS based on the existing adult SIC criteria.

Results

Among 432 pediatric patients with septic shock, those with elevated modified pSIC score demonstrated significantly worse baseline characteristics and higher risks of adverse outcomes. The modified pSIC score exhibited higher predictive value for 28-day mortality compared to previous scores and maintained good predictive ability and high sensitivity for overt DIC. Survival curves confirmed significantly higher 28-day mortality in the high pSIC group than in the low pSIC group (38.2 % vs 12.8 %, p < 0.001).

Conclusions

In this single-center cohort of pediatric septic shock patients, the modified pSIC score demonstrated good diagnostic and prognostic utility for sepsis-induced coagulopathy under updated sepsis criteria. However, its effectiveness still needs to be further validated in broader pediatric sepsis population.