Indian pediatrics · 2026
Prognostic Accuracy of Serially Measured Organ Dysfunction Scores in Children with Fluid Refractory Septic Shock.
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Sharma Ritu, Chattopadhyay Arpita, Saikia Diganta, Singhal Nehal, Crasto Alisha Austin, Sharma Mimansa
Аннотация
OBJECTIVES: To evaluate the prognostic accuracy of serially measured PEdiatric Logistic Organ Dysfunction (PELOD)-2 and pediatric Sequential Organ Failure Assessment (pSOFA) scores for predicting 28-day in-hospital mortality in pediatric fluid-refractory septic shock.
METHODS: Children aged < 12 years admitted to the pediatric intensive care unit (PICU) with fluid-refractory septic shock were enrolled. PELOD-2 and age-adapted pSOFA scores were compared using crude and adjusted area under the receiver operating characteristic curve (AUROC) analysis over the first four days of PICU admission.
RESULTS: Of the 93 children analyzed, 38 (40.9%) died, and 45 (48.4%) experienced a PICU length of stay ≥ 7 days. The sensitivity of PELOD-2 (score ≥ 8) to predict 28-day in-hospital mortality increased from 60.5 on day 1 to 84.2% on day 4, whereas that of pSOFA (score ≥ 8) increased from 47.4 to 63.2%. Discriminative power improved over time, with adjusted AUROC for mortality prediction increasing from day 1 to day 4 for both PELOD-2 (0.69 to 0.90) and pSOFA (0.69 to 0.88).
CONCLUSIONS: In children with fluid-refractory septic shock, PELOD-2 and pSOFA scores demonstrated increasing prognostic accuracy for 28-day in-hospital mortality when assessed serially, with better discrimination on day 4 compared with baseline scores at admission.
METHODS: Children aged < 12 years admitted to the pediatric intensive care unit (PICU) with fluid-refractory septic shock were enrolled. PELOD-2 and age-adapted pSOFA scores were compared using crude and adjusted area under the receiver operating characteristic curve (AUROC) analysis over the first four days of PICU admission.
RESULTS: Of the 93 children analyzed, 38 (40.9%) died, and 45 (48.4%) experienced a PICU length of stay ≥ 7 days. The sensitivity of PELOD-2 (score ≥ 8) to predict 28-day in-hospital mortality increased from 60.5 on day 1 to 84.2% on day 4, whereas that of pSOFA (score ≥ 8) increased from 47.4 to 63.2%. Discriminative power improved over time, with adjusted AUROC for mortality prediction increasing from day 1 to day 4 for both PELOD-2 (0.69 to 0.90) and pSOFA (0.69 to 0.88).
CONCLUSIONS: In children with fluid-refractory septic shock, PELOD-2 and pSOFA scores demonstrated increasing prognostic accuracy for 28-day in-hospital mortality when assessed serially, with better discrimination on day 4 compared with baseline scores at admission.