PELOD Score Research Articles

Changes in the serum levels of clusterin in children with sepsis

Aim: The first aim of this study was to determine levels of clusterin in pediatric patients with systemic inflammatory response syndrome or septic state, comparing these levels with a healthy population. The second objective was to compare levels of clusterin within individual septic conditions, influence of levels of these proteins on mortality. Background: Clusterin is a highly conserved protein which is expressed at increased levels by many cell types in response to a broad variety of stress conditions. Methods: Fifty-seven children aged 0–19 years (30 boys and 27 girls) hospitalized from June 2009 to March 2011, with expected or proven SIRS and septic condition. The degree of severity was evaluated according PELOD Score. Blood tests to determine levels of clusterin were taken throughout the patient meets the criteria of SIRS or sepsis. Control group to determine the serum levels of clusterin has been taken from patients undergoing elective surgery. Results: We found lower concentrations of clusterin in patients with SIRS or septic state, than in the control group. Clusterin cut-off for first day – D1 was 91.04μg/ml; AUC 0.900; p-value <0.001; for third day – D3 was cut-off 86.73μg/ml; AUC 0.849; p-value <0.001; for fifth day – D5 cut-off was 105.26μg/ml; AUC 0.755; p-value <0.001. Effect of clusterin levels on mortality in the dynamics was recorded significant for 5 days in groups non-survivors/survivors, p-value 0.004. Conclusion: We have demonstrated a decrease clusterin levels in pediatric patients with septic state, and its effect on mortality.

228 Factors Associated with Constipation in A Pediatric Intensive Care Unit

Backgrounds and aimsConstipation is a frequent complication in critically ill patients although there are few studies in children.MethodsProspective observational study with children admitted in the PICU for more than 3...

815 Patients with Primary Immunodeficiency Disorders in Pediatric Intensive Care Unit: Outcomes and Mortality-Associated Risk Factors

IntroductionPrimary immunodeficiency disorders (PID) are characterized by poor or absent function in one or more components of the immune system. Early diagnosis and treatment is crucial for preventing morbidity and...

Predicting PICU patient survival prognosis: Pediatric Logistic Organ Dysfunction vs Pediatric Index of Mortality scores

Background Determining prognosis of patients using scoringsystems have been done in many pediatric intensive care units(PICU). The scoring systems frequently used are pediatric logisticorgan dy sfunction (PELOD), pediatric index of mortality (PIM)and pediatric risk of mortality (PRISM).Objective To compare the performance of PELOD and PIM scoresin predicting the prognosis of survival vs death in PICU patients.Methods A prognostic test in this prospective, cohort study wasconducted in the PICU of the Kariadi General Hospital, Semarang.PELOD and PIM calculations were performed using formulae frompreviously published articles. Statistical analyses included receiveroperating curve (ROC) characteristics to describe discriminationcapacity, sensitivity, specificity, positive predictive value, negativepredictive value and accuracy.Results Thirty-three patients fulfilling the inclusion criteria wereenrolled in the study. PELOD score for area under the ROCwas 0.87 (95% CI 0.73 to 1.0; P=0.003), while that for PIMwas 0.65 (95% CI 0.39 to 0.90; P=0.2). PELOD scores showedsensitivity 85.7% (95% CI 59.8 to 100), specificity 84.6% (95%CI 70.7 to 98.5), positive predictive value 60.0% (95% CI 29.6to 90.4) negative predictive value 95.6% (95% CI 87.3 to 100)and accuracy 84.8%. PIM scores showed sensitivity 85.7% (95%CI 59.8 to 100), specificity 50.0% (95% CI 30.8 to 69.2), positivepredictive value 31.6% (95% CI 10,7 to 52.5), negative predictivevalue 92.9% (95% CI 79.4 to 100) and accuracy 57.6%.Conclusion PELOD scoring had better specificity, positive predictivevalue, negative predictive value, accuracy and discrimination capacitythan PIM scoring for predicting the survival prognosis of patients inthe PICU. [Paediatr Indones. 2012;52:165-9].

Kawasaki disease: an unexpected etiology of shock and multiple organ dysfunction syndrome

Severe forms of Kawasaki disease (KD) associated with shock have recently been reported in which a greater number of coronary artery abnormalities (CAA) were observed. In this study, we analyzed organ involvement not restricted to cardiovascular aspects in severe KD and assessed whether their outcome is different than in common forms. Retrospective study. A 12-bed pediatric intensive care unit (PICU) in a university hospital setting. All patients managed in the PICU with a diagnosis of KD from 1 January 2001 to 30 April 2009. Eleven patients were admitted because of moderate febrile shock without initial KD diagnosis. Median age was 75months (6-175) with a male:female ratio of 1.4. KD was diagnosed and treated after a delay of 1day (0-2), for a total of 7days (5-9) after fever onset. Seven patients (63%) developed CAA after 21days (6-30) with complete regression within a delay of 120days (18-240). Nonspecific encephalopathy (n=6) as well as acute kidney injury (n=10) were also observed. Multiple organ dysfunction syndrome (MODS) occurred in eight patients. Although predicted mortality according to the PELOD score [21 (10-43)] ranged from 20% to up to 50%, all 11 children survived with no sequelae. Moderate shock is the main reason for PICU admission in children suffering from KD. These forms can be associated with surprising MODS. Despite the severity of symptoms, all patients survived without any sequelae, hence the need for proper diagnosis and rapid treatment of these unusual severe forms.

Early elevations in B‐type natriuretic peptide levels are associated with poor clinical outcomes in pediatric acute lung injury

To determine B-type natriuretic peptide (BNP) levels in infants and children with acute lung injury (ALI), and to investigate associations between BNP levels and clinical outcome. Prospective observational study. After informed consent, plasma was collected from 48 pediatric patients on day 1 of ALI. Plasma BNP levels were measured by immunoassay on day 1 of ALI in 48 pediatric patients. Associations between BNP levels and outcome were determined. The mean PaO(2)/FiO(2) at the onset of ALI was 155 (+/-74) and BNP values ranged from 5 to 2,060 pg/ml with a mean of 109 (+/-311). BNP levels were inversely correlated with ventilator-free days (Spearman rho -0.30, P = 0.04), and positively correlated with exhaled tidal volume (Spearman rho 0.44, P = 0.02). BNP levels were higher in patients receiving inotropic support (n = 12) than patients not receiving inotropic support (n = 33, P = 0.02). BNP levels were correlated with PRISM III scores (Spearman rho 0.55, P < 0.001) and PELOD scores (Spearman rho 0.4, P = 0.006). Mortality for the cohort was 15%. BNP levels were higher in non-survivors (n = 7) than survivors (n = 41, P = 0.055). BNP levels are elevated in children with ALI/ARDS early in the disease course, and increased levels are associated with worse clinical outcome.

Microalbuminuria Levels Are Correlated with PELOD Scores in Critically Ill Children

Microalbuminuria Levels Are Correlated with PELOD Scores in Critically Ill Children