PELOD-2 Score Research Articles

Daily estimation of the severity of organ dysfunctions in critically ill children by using the PELOD-2 score.

IntroductionDaily or serial evaluation of multiple organ dysfunction syndrome (MODS) scores may provide useful information. We aimed to validate the daily (d) PELOD-2 score using the set of seven days proposed with the previous version of the score.MethodsIn all consecutive patients admitted to nine pediatric intensive care units (PICUs) we prospectively measured the dPELOD-2 score at day 1, 2, 5, 8, 12, 16, and 18. PICU mortality was used as the outcome dependent variable. The discriminant power of the dPELOD-2 scores was estimated using the area under the ROC curve and the calibration using the Hosmer-Lemeshow chi-square test. We used a logistic regression to investigate the relationship between the dPELOD-2 scores and outcome, and between the change in PELOD-2 score from day1 and outcome.ResultsWe included 3669 patients (median age 15.5 months, mortality rate 6.1 %, median length of PICU stay 3 days). Median dPELOD-2 scores were significantly higher in nonsurvivors than in survivors (p < 0.0001). The dPELOD-2 score was available at least at day 2 in 2057 patients: among the 796 patients without MODS on day1, 186 (23.3 %) acquired the syndrome during their PICU stay (mortality 4.9 % vs. 0.3 % among the 610 who did not; p < 0.0001). Among the1261 patients with MODS on day1, the syndrome worsened in 157 (12.4 %) and remained unchanged or improved in 1104 (87.6 %) (mortality 22.9 % vs. 6.6 %; p < 0.0001). The AUC of the dPELOD-2 scores ranged from 0.75 (95 % CI: 0.67-0.83) to 0.89 (95 % CI: 0.86-0.91). The calibration was good with a chi-square test between 13.5 (p = 0.06) and 0.9 (p = 0.99). The PELOD-2 score on day1 was a significant prognostic factor; the serial evaluation of the change in the dPELOD-2 score from day1, adjusted for baseline value, demonstrated a significant odds ratio of death for each of the 7 days.ConclusionThis study suggests that the progression of the severity of organ dysfunctions can be evaluated by measuring the dPELOD-2 score during a set of 7 days in PICU, providing useful information on outcome in critically ill children. Its external validation would be useful.

O-096 Non-respiratory Pelod-2 Score Is A Good Predictor Of Mortality In Children With Acute Respiratory Failure

Background and aim Multiple organ dysfunction, not respiratory failure, is the major cause of death in children with ALI or ARDS. This study was undertaken to estimate the predictive value of death of the non-respiratory Paediatric Logistic Organ Dysfunction (PELOD)-2 (NRespPELOD-2) in children with acute respiratory failure (ARF). Methods Analysis of the database of the recently published PELOD-2. All consecutive children (excluding neonates) admitted to 9 PICU in France and Belgium (June 2006–October 2007) and having ARF. We prospectively collected data on variables considered for the PELOD-2 score during PICU stay: days 1, 2, 5, 8, 12, 16 and 18, plus PICU discharge. For each variable of the PELOD-2 score, the most abnormal value observed during time points was collected. Outcome was vital status at PICU discharge. We used AUCs to estimate the discrimination and Hosmer-Lemeshow goodness-of-fit tests to estimate calibration of the PELOD-2 and the NRespPELOD-2 scores, with correction for the optimism bias using a bootstrap resampling method. Results We included 1572 patients (median age: 20.6 months; mortality: 9.5%). Discrimination of the PELOD-2 and the NRespPELOD-2 was excellent (AUC=0.93 and 0.92, respectively) and calibration was good (p = 0.45 and 0.27, respectively). The four NResp organ dysfunctions were closely related to the risk of mortality (p Conclusions Our study demonstrates that the NRespPELOD-2 score of the entire PICU stay is highly predictive of death in children with ARF of whom 94.3% were invasively ventilated. It could represent the non-respiratory organ failure definition tool claimed by the international experts on paediatric ARDS.

99 PELOD-2: An Update of the Pediatric Logistic Organ Dysfunction Score

Background and aimsOrgan dysfunction scores, such as the PEdiatric Logistic Organ Dysfunction (PELOD) score developed in 1999, are primarily designed to describe the severity of organ dysfunction. This study was...