Markers of adverse sepsis outcome in pediatric infections

Introduction. Assessing the severity of the condition and predicting the outcome of sepsis in infectious diseases in children is one of the most serious problems of intensive care in pediatrics.

The objective was to assess the discriminatory ability of scales of severity of multiple organ dysfunction in children with sepsis in severe acute infectious diseases.

Materials and methods. 236 children with sepsis developed against the background of a severe course of infectious diseases were examined. Mean age was 4.15 years [1 month; 17 years]. The median duration of treatment in the ICU was 9.48 days [2 hours; 32 days], and the duration of mechanical ventilation was 3.8 days. Mortality was 12.2% (29 patients). Multiple organ dysfunction scales PELOD2, PRISM3 and pSOFA, Phoenix were used to assess the severity of the condition and predict outcome.

Results. All children with sepsis had multiple organ dysfunction on admission to ICU. Five clinical laboratory features were identified that can be considered as markers of an unfavorable outcome: Glasgow coma scale (cut off ≤ 11; OR = 5.41; 95%CI = 0.13–0.36); plasma creatinine (cut off > 49; OR = 3.32; 95%CI = 0.48–0.77); white blood cell count (cut off ≤ 11.5; OR = 8.33; 95%CI = 0.18–0.5); thrombocytopenia (cut off ≤ 81; OR = 6.44; 95%CI = 0.25–0.6) and SpO2 /FiO2 ratio (cut off ≤ 286; OR = 4.97; 95% CI = 0.09–0.37). The maximum predictive ability for assessing the probability of an unfavorable outcome was noted on the pSOFA scale (AUC = 0.717).

Conclusion. The pSOFA scale has the highest sensitivity and specificity for predicting the risk of death in children with sepsis of infectious genesis.

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