Prognostic performance of the temperature- and age-modified shock index for children with sepsis and septic shock: a retrospective cohort study.

BACKGROUND

Pediatric septic shock is associated with high mortality and morbidity rates. Lactate levels are monitored to determine the quality of sepsis treatment; however, some rural hospitals have restricted access to lactate measurements because of limited resources. This study evaluated the prognostic performance of the temperature- and age-modified shock index (TAMSI) for sepsis and septic shock in children and its ability to predict morbidity and mortality.

METHODS

Data on children with sepsis or septic shock (age 1 month–15 years) who were admitted to the Songklanagarind Hospital pediatric intensive care unit between January 2017 and May 2022 were retrospectively reviewed. Vital signs were collected at 0, 1, 6, 12, and 24 h (t0, t1, t6, t12, t24, respectively) after sepsis diagnosis. The TAMSI cutoff scores according to age groups were referenced from the Pediatric Advanced Life Support (PALS) guidelines.

RESULTS

The final analysis included 300 children (171 [57%] male children) with a mean age of 73.9 months (standard deviation [SD], 63.5 months); 192 (67%) of these children were immunocompromised. The median pediatric risk of mortality score was 6 (interquartile range, 3–10). Eighty-two (27.3%) deaths occurred. The TAMSI areas under the receiver-operating characteristic curve at 0, 1, 6, 12, and 24 h for predicting mortality were 0.55, 0.58, 0.62, 0.66, and 0.67, respectively. In the multivariable logistic regression analysis, an abnormal TAMSI at t6 was significantly associated with hospital mortality (abnormal TAMSI at t0 and abnormal TAMSI at t6: adjusted odds ratio [aOR], 2.95; 95% confidence interval [CI], 1.44–6.13; P = 0.003; normal TAMSI at t0 and abnormal TAMSI at t6: aOR, 4.61; 95% CI, 1.48–14.63; P = 0.008).

CONCLUSIONS

Based on the PALS guidelines, an abnormal TAMSI at 6 h after sepsis was significantly associated with mortality. The TAMSI can be a useful noninvasive monitoring tool for pediatric sepsis or septic shock at resource-limited hospitals. CLINICAL TRIAL NUMBER: Not applicable.