PELOD Score Research Articles

The Association of PELOD-2 Score and Nutritional Status of Children Treated in the Pediatric Intensive Care Unit at Prof. Dr. I.G.N.G. Ngoerah Hospital Denpasar, 2020-2022

Background: The Pediatric Logistic Organ Dysfunction (PELOD-2) is used to measure the severity of vital organ dysfunction due to disease or other medical conditions in pediatric patients admitted to the Pediatric Intensive Care Unit (PICU). Nutritional status is a crucial factor affecting the body's ability to fight disease and the risk of complications. The aim was to evaluate the association between PELOD-2 scores and nutritional status in children treated in the PICU of Prof. Dr. I.G.N.G. Ngoerah Hospital Denpasar. Methods: This study employed a retrospective cross-sectional design using medical record data of children aged 1 month to 18 years treated in the PICU of Prof. Dr. I.G.N.G. Ngoerah Hospital Denpasar from January 2020 to December 2022. Data were collected from 428 subjects meeting the inclusion and exclusion criteria. Data analysis was performed using Chi-Square tests and logistic regression. Results: The study results indicated that PELOD-2 scores were significantly associated with poor nutritional status (OR: 1.71; 95% CI: 1.107–2.73), ventilator use (OR: 5.4; 95% CI: 3.336–8.913), and gender, with males being at higher risk (OR: 1.66; 95% CI: 1.042–2.654). Older age was found to be a protective factor against high PELOD-2 scores (ExpB: 0.996; 95% CI: 0.993–1.00). Conclusion: PELOD-2 scores are significantly associated with poor nutritional status, age, ventilator use, and gender in children treated in the PICU.

Therapeutic plasma exchange in critically ill children: A single center experience.

Therapeutic plasma exchange (TPE) is used in a wide spectrum of diseases in critically ill pediatric patients. We aim to review the indications, complications, safety, and outcomes of critically ill children who received TPE. All of the TPE procedures performed in a pediatric intensive care unit providing tertiary care during 19 years (January 2013-January 2023) were evaluated retrospectively. A total of 154 patients underwent 486 TPE sessions. Median age was 6 years (2-12.5) and 35 children had a body weight of <10 kg (22.7%). Number of organ failure was 4 (2-6). Liver diseases were the most common indication for TPE (31.2%) followed by sepsis with multiorgan dysfunction syndrome (27.3%). Overall survival rate was 72.7%. The highest mortality was observed in hemophagocytic lymphohistiocytosis group. Non-survivors had significantly higher number of organ failure (p < 0.001), higher PRISM score (p < 0.001), and higher PELOD score on admission (p < 0.001). Adverse events were observed in 68 (13.9%) sessions. Hypotension (7.8%) and hypocalcemia (5.1%) were the most frequent adverse events. TPE is safe for critically ill pediatric patients with experienced staff. Survival rate may vary depending on the underlying disease. Survival decreases with the increase in the number of failed organs.

Development and validation of an early mortality risk model for pediatric hemophagocytic lymphohistiocytosis: a comparison with HScore, PELOD-2, P-MODS, and pSOFA.

There has been no severity evaluation model for pediatric patients with hemophagocytic lymphohistiocytosis (HLH) that uses readily available parameters. This study aimed to develop a novel model for predicting the early mortality risk in pediatric patients with HLH using easily obtained parameters whatever etiologic subtype. Patients from one center were divided into training and validation sets for model derivation. The developed model was validated using an independent validation cohort from the second center. The prediction model with nomogram was developed based on logistic regression. The model performance underwent internal and external evaluation and validation using the area under the receiver operating characteristic curve (AUC), calibration curve with 1000 bootstrap resampling, and decision curve analysis (DCA). Model performance was compared with the most prevalent severity evaluation scores, including the PELOD-2, P-MODS, and pSOFA scores. The prediction model included nine variables: glutamic-pyruvic transaminase, albumin, globulin, myohemoglobin, creatine kinase, serum potassium, procalcitonin, serum ferritin, and interval between onset and diagnosis. The AUC of the model for predicting the 28-day mortality was 0.933 and 0.932 in the training and validation sets, respectively. The AUC values of the HScore, PELOD-2, P-MODS and pSOFA were 0.815, 0.745, 0.659 and 0.788, respectively. The DCA of the 28-day mortality prediction exhibited a greater net benefit than the HScore, PELOD-2, P-MODS and pSOFA. Subgroup analyses demonstrated good model performance across HLH subtypes. The novel mortality prediction model in this study can contribute to the rapid assessment of early mortality risk after diagnosis with readily available parameters.

Two months outcomes following delirium in the pediatric intensive care unit.

The lasting consequences of delirium in children are not well characterized. This study aimed to compare the two-month outcomes in pediatric intensive care unit (PICU) survivors according to the presence of delirium. Post-hoc analysis of a single-center prospective study of mechanically ventilated (invasive ventilation or non-invasive ventilation) children followed at the CHU Sainte-Justine PICU follow-up clinic two months after PICU discharge, between October 2018 and August 2022. Delirium was defined as one or more Cornell Assessment of Pediatric Delirium (CAPD) scores ≥ 9. Primary outcome was survivors' quality of life and secondary outcomes were sleep and posttraumatic stress and anxiety and depression in parents. Multivariable linear and logistic regression models assessed the independent associations between delirium and outcomes while adjusting for age, sex, comorbidity, diagnosis, severity of illness, PICU length of stay, and invasive mechanical ventilation. Of the 179 children included over a 47 month-period, 117 (65.4%) had delirium. Children with delirium were more commonly intubated (91.5% vs. 30.7%, p < 0.001) and had higher PELOD-2 scores (10 vs. 4, p < 0.001). On multivariable analysis, delirium was associated with a decreased quality of life at 2.3 months post discharge (p = 0.03). The severity of the delirium episode (higher scores of CAPD) was associated with a higher likelihood of sleep disturbances (OR 1.13, p = 0.01) and parental anxiety (OR 1.16, p = 0.01), in addition to lower quality of life (p = 0.03).Conclusions: Two months following their PICU stay, children with delirium had a lower quality of life, suggesting a lasting effect of delirium on children and their families.

In Vivo Analysis of Tissue S-Nitrosothiols in Pediatric Sepsis.

S-nitrosothiols are endogenous, bioactive molecules. S-nitrosothiols are implicated in many diseases, including sepsis. It is currently cumbersome to measure S-nitrosothiols clinically. We have previously developed an instrument to measure tissue S-nitrosothiols non-invasively using ultraviolet light. We have performed a prospective case control study of controls and children with sepsis admitted to the PICU. We hypothesized that tissue S-nitrosothiols would be higher in septic patients than controls. Controls were patients with no cardiopulmonary instability. Cases were patients with septic shock. We measured S-nitrosothiols, both at diagnosis and after resolution of shock. A total of 44 patients were enrolled: 21 controls and 23 with sepsis. At baseline, the controls were younger [median age 5 years (IQR 0, 9) versus 11 years (IQR: 6, 16), p-value = 0.012], had fewer comorbidities [7 (33.3%) vs. 20 (87.0%), p-value < 0.001], and had lower PELOD scores [0 (IQR: 0, 0) vs. 12 (IQR: 11, 21), p-value < 0.001]. S-nitrosothiol levels were higher in sepsis cohort (1.1 ppb vs. 0.8 ppb, p = 0.004). Five patients with sepsis had longitudinal measures and had a downtrend after resolution of shock (1.3 ppb vs. 0.9 ppb, p = 0.04). We dichotomized patients based on S-nitrosothiol levels and found an association with worse clinical outcomes, but further work will be needed to validate these findings.

Validating the performance of organ dysfunction scores in children with infection: A cohort study.

We aimed to validate the performance of six available scoring models for predicting hospital mortality in children with suspected or confirmed infections. This single-center retrospective cohort study included pediatric patients admitted to the PICU for infection. The primary outcome was hospital mortality. The six scores included the age-adapted pSOFA score, SIRS score, PELOD2 score, Sepsis-2 score, qSOFA score, and PMODS. Of the 5,356 children admitted to the PICU, 9.1% (488) died, and 25.1% (1,342) had basic disease with a mortality rate of 12.7% (171); 65.3% (3,499) of the patients were younger than 2 years, and 59.4% (3,183) were male. The discrimination abilities of the pSOFA and PELOD2 scores were superior to those of the other models. The calibration curves of the pSOFA and PELOD2 scores were consistent between the predictions and observations. Elevated lactate levels were a risk factor for mortality. The pSOFA and PELOD2 scores had superior predictive performance for mortality. Given the relative unavailability of items and clinical operability, the pSOFA score should be recommended as an optimal tool for acute organ dysfunction in pediatric sepsis patients. Elevated lactate levels are related to a greater risk of death from infection in children in the PICU.

Pediatric Critical Care Illness Severity Toolkit: Stata Commands for Calculation of Pediatric Index of Mortality and Pediatric Logistic Organ Dysfunction Scores.

Illness severity scoring tools, such as PRISM III/IV, PIM-3, and PELOD-2, are widely used in pediatric critical care research. However, their application is hindered by complex calculation processes, privacy concerns with third-party online calculators, and challenges in accurate implementation within statistical packages. We have developed a comprehensive, open-source toolkit for implementing the PIM-3, Simplified PIM-3, and PELOD-2 scores. The toolkit includes the pim3 and pelod2 commands and is compatible with Stata versions 12 and above. It features robust data validation, error messaging, a graphical interface, and support for SI and Imperial units. The toolkit's accuracy was validated through unit testing and synthetic data, comparing results with existing implementations. In performance tests, the toolkit exhibited a median processing time of 21.82 seconds for PELOD-2, 14.06 seconds for PIM-3, and 9.74 seconds for Simplified PIM-3, when applied to datasets of 10,000,000 records. It consistently achieved 100% accuracy in both synthetic data tests and manual spot checks. The toolkit decreases processing time and improves accuracy in calculating pediatric critical care severity scores such as PELOD-2, PIM-3, and Simplified PIM-3. Its application in large datasets and validation highlights its utility as a tool for streamlining pediatric critical care research.

Neutrophil lymphocyte ratio and severity of acute kidney injury in septic children

Background Acute kidney injury (AKI) in sepsis is associated with an inflammatory process in kidney microcirculation and may increase morbidity and mortality in children. The neutrophil lymphocyte ratio (NLR) is an inflammatory biomarker of the inflammatory process in sepsis.&#x0D; Objective To determine the role of NLR in predicting the severity of AKI and to describe the demographic and laboratory characteristics, as they relate to outcomes of pediatric patients with AKI and sepsis.&#x0D; Methods This cross-sectional study was conducted in the PICU at Dr. Zainoel Abidin General Hospital (RSUDZA), Banda Aceh, Aceh. Medical record data were obtained from critically ill children with sepsis and AKI. Chi-square test was used to compare the proportions of each variable. We also calculated odds ratios to evaluate the AKI severity, PELOD-2 score, and patient outcomes. Spearman's analysis was used to look for a possible correlation between NLR and AKI severity in septic children.&#x0D; Results Seventy-one subjects with sepsis and AKI were included. Subject characteristics were as follows: 63.4% males, 63.4% &lt; 1 year of age, 56.3% with respiratory problems as a primary disease, 38% with AKI injury stage, and 54.9% subjects with PELOD-2 score ?10. There was no significant correlation between AKI severity and mortality (OR 3.04; 95%CI 0.990 to 9.378; P=0.052). Subjects with a PELOD-2 score ?10 had a 47.6 times higher chance of mortality in septic children with AKI compared to those with PELOD-2 scores &lt;10. There was no correlation between NLR and AKI severity (r=0.019; P=0.878).&#x0D; Conclusion There is no correlation between NLR and AKI severity. Sepsis accompanied by AKI may increase the risk of mortality in children. Septic children with more severe AKI tends to be less survive.

A Retrospective Study on the Availability of Arterial Lactate Levels as a Biomarker of Mortality in Critically Ill Children

Objective: We aimed to determine the threshold value of lactate levels, and to analyze its avaliability as mortality biomarker by correlating it with scoring systems in pediatric intensive care unit (PICU). Material and Methods: Observational retrospective cohort study. Our study was conducted among patients admitted to the 24-bed tertiary PICU of our hospital in 2015. All children between the ages of 1 month and 18 years were evaluated. Among 433 patients whose arterial blood gases were obtained during hospitalization, a total of 382 were included in the study. Patients with congenital metabolic disease with lactic acidosis were excluded. The arterial blood lactate levels on admission, PIM-2, PRISM-III and PELOD scores and survival status of the patients were evaluated. Correlation between lactate levels and mortality scores, threshold values of lactate levels and the factors affecting mortality risk were the main variable of interest. Results: There was a significant correlation between lactate levels and scores in patients who died (p&amp;lt;0.001). Receiver operating characteristic (ROC) curve analysis showed that blood lactate level was an effective parameter on mortality (area under the curve=AUC: 0.861; p&amp;lt;0.001) with a cut-off value of 2.55 mmol/L. The mortality risk was 1.38 fold higher in patients with higher levels of lactate. Conclusion: In our series, the levels of lactate were higher in critically ill children who died. Again, lactate levels and mortality scores of these children were correlated. In our series, the levels of lactate were higher in critically ill children who died. Again, lactate levels and mortality scores of these children were correlated. We were able to establish a cut-off point with high specificity for predicting evolution. These findings should be validated in prospective and multicenter studies for their incorporation into scoring systems.

Cytomegalovirus Active Infection in Critically Ill Children.

To describe the epidemiology, clinical characteristics and outcomes of children with cytomegalovirus (CMV) active infection in the pediatric intensive care unit (PICU) and to investigate risk factors for mortality. This was a retrospective cohort study of patients who had CMV DNA detected in blood samples and/or tracheal aspirates by polymerase chain reaction (PCR) during stay at 2 PICUs of a university hospital. Suspected cases without etiological confirmation and patients with laboratory-confirmed CMV infection before PICU admission were excluded. Demographic, clinical and outcome data were collected from medical records. From January 1, 2012, to December 31, 2019, 4748 children were admitted to the PICUs. Thirty-five (0.74%; 95% CI 0.51%-1.02%) had laboratory-confirmed CMV active infection; 71.4% were immunocompromised and 11 (31.4%) died. Patients who died were older than those who survived (median age 65 vs. 5.5 months, respectively; P = 0.048), and they received antiviral therapy for a shorter time (median 12 vs. 23 days, respectively; P = 0.001). The main causa mortis was septic shock (82%) and in most deceased patients (73%) the last CMV PCR before death was positive. PELOD score >6 was a risk factor for death (RR 2.96; 95% CI 1.07-8.21). Viral load in blood had a poor ability for the prediction of death (area under the receiver operating characteristic curve 0.62; 95% CI 0.37-0.84). The incidence of CMV active infection during PICU stay was 0.74% in an upper-middle income country with a high CMV seroprevalence. PELOD score higher than 6 was a risk factor for death. No association was observed between CMV viral load and mortality.

Correlation Between Free Triiodothyronine (FT3) with PELOD-2 Score and PICU Length of Stay in Critically Ill Pediatric

Background: Thyroid function disorders, particularly reduced FT3 levels, are frequently observed in critically ill patients. FT3 plays a crucial role in metabolic regulation during critical illness. The extent of the decrease in FT3 levels directly corresponds to the severity of the disease, as indicated by the PELOD-2 score, and indirectly influences the length of stay in the Pediatric Intensive Care Unit (PICU). This study aims to examine the relationship between free triiodothyronine (FT3) levels and both the PELOD-2 score and the length of stay in critically ill pediatric patients. Methods: Cross-sectional study was conducted at Dr. M Djamil Hospital's Pediatric Intensive Care Unit (PICU) from June to September 2022. The study included critically ill pediatric patients who accept the informed consent and were well-nourished, while individuals with a history of thyroid disease, those using exogenous/thyroid hormone/antithyroid drugs, individuals with chronic diseases, and those with Down's syndrome were excluded. The levels of FT3 and PELOD-2 scores were measured within 48 hours of admission, while the length of stay was obtained from medical records. Data analysis was performed using the SPSS program, utilizing the Spearman correlation test. Result: Thirty subjects were included in the study. The mortality rate was 30%. The median FT3 level was 1.5 pg/mL. FT3 levels were low in 26 of 30 samples. There was a significant negative correlation (p = 0,001) between FT3 levels and PELOD-2 scores with moderate value (r = -0.567) and no significant correlation between FT3 levels and PICU length of stay. Conclusion: The lower FT3 level measured, the higher PELOD-2 score found in critically ill children. Keywords: FT3, PELOD-2 score, length of stay, critically ill pediatric

The Various Scoring Systems in Pediatric Intensive Care Units: A Prospective Observational Study.

The discrimination power of the pediatric risk of mortality (PRISM), pediatric index of mortality (PIM), sequential organ failure assessment (SOFA), and pediatric logistic organ dysfunction (PELOD) may not always be true for countries such as India due to differences in factors from those nations where these scoring systems were validated. Therefore, this study was undertaken to determine and compare severity, course of illness, and outcomes in critically ill children admitted to the pediatric intensive care unit (PICU) using different scoring systems such as PRISM 4, PIM 3, PELOD 2, and the pediatric sequential organ failure assessment (pSOFA ) score, and to analyze the clinical spectrum and demographic profile of children admitted to the PICU. This was a prospective, single-center, observational study conducted in the PICU of the Indira Gandhi Institute of Medical Science, Patna, India, over two years. Two hundred children in the age group of one month to 14 years admitted to the PICU were recruited into the study. Prognostic scoring systems, including PRISM4 and PIM3, were used to compare the outcome, mortality, and length of PICU stay, whereas PELODS and pSOFA were descriptive scores that assessed the multiorgan dysfunction. A correlation between the different scoring systems and the outcome was determined. The majority of children (26.5%, n=53) were one to three years of age. The maximum number of patients was male (66.5%, n=133). Renal complications were the predominant admission diagnosis in 19% (n=38) of children. The mortality rate was found to be 18.5%. The mortality was most common in infants <1 year of age (n=11, 29.73%) and those of the male sex (n=22, 59.46%). A significant correlation was found between length of stay and mortality (p<0.00001). A significant positive correlation was observed between mortality and PRISM 4, PIM 3, PELOD 2, and pSOFA scores on the first day of admission (p<0.00001). The pSOFA and PELOD2 showed better discrimination power (area under the curve (AUC): 0.77 and 0.74, respectively). The study concluded that the pSOFA and PELOD2 scores are reliable predictors of mortality in critically ill children.

The Role of Blood Purification by HA330 as Adjunctive Treatment in Children with Septic Shock

Introduction: Despite advances in supportive care for critically ill patients, sepsis remains an important cause of death worldwide in the PICU. One of the hallmarks of sepsis is hyperinflammation due to the excessive release of inflammatory mediators. Recently, new therapeutic approaches, such as immune modulation and blood purification, have been tried to improve outcomes in patients with septic shock. Methods: This study is a prospective observational study composed of children with septic shock and the PELOD-2 score ≥10 or the PRISM-3 score ≥15. All received 2–4 h of HA330 treatment on 2 consecutive days, used as adjunctive therapy. The effectiveness of HA330 hemoperfusion was evaluated by improving the PELOD-2 and PRISM-3 scores, the vasoactive inotropic score (VIS), and inflammatory markers from baseline to 72 h after the use of HA330 hemoperfusion. Results: Twelve patients hospitalized in the PICU and diagnosed with septic shock between July 2021 and May 2022 were included in this study and received hemoperfusion with HA330. The average PELOD-2 and PRISM-3 scores decreased significantly from 9.5 (IQR: 6.5–13.0) at baseline to 2.0 (IQR: 0–6.5) at 72 h (p = 0.002) and from 16.5 (IQR: 15.0–20.5) at baseline to 5.5 (IQR: 2.0–9.5) at 72 h (p = 0.002), respectively. The VIS decreased significantly from baseline to 72 h (p = 0.003). IL-6, procalcitonin, and lactate levels also decreased significantly from baseline to 72 h (p = 0.005, 0.03, and 0.03, respectively). Two of 12 patients expired due to their underlying condition (2/12, 16.7%). Device-related adverse events did not occur in this study. Conclusions: Our observational case series suggests a possible role for HA330 hemoperfusion as an adjunctive treatment of refractory septic shock in children with high severity scores in the context of rapid improvement in organ dysfunction, without serious adverse effects.

Comparative Analysis of Intensive Care Prognosis Scoring Systems and Acute Kidney Injury Scores (AKIN and pRIFLE) in Critically Ill Children

A total of 716 children, whose serum creatinine levels were within the normal limits at the time of admission to the PICU between January 2018 and December 2020, were included. Along with the demographic and clinical variables, AKIN and pRIFLE classifications were recorded at the most advanced stage of AKI. Along with the PIM-2, PRISM III, and PELOD-2 scores, the highest value of the pSOFA score was recorded. According to the pRIFLE and AKIN classifications, 62 (8.7%) patients developed kidney injury, which had a statistically significant effect on mortality. The occurrence of renal injury was found to be statistically strongly and significantly correlated with high PRISM III, PELOD-2, and pSOFA scores. When the stages of kidney injury according to the AKIN criteria were compared with the PRISM III, PELOD 2, and pSOFA scores, a significant difference was found between the patients who did not develop AKI and those who developed stage 1, stage 2, and stage 3 kidney injury. For the PRISM III, PELOD 2, and pSOFA scores, there were no significant differences between the stages according to the AKIN criteria. A substantial difference was discovered between the patients who did not develop AKI and those who were in the risk, injury, and failure plus loss stages according to the pRIFLE criteria. According to the PIM-2 ratio and pRIFLE criteria, there was a statistically significant difference between patients in the injury and failure plus loss stages and those who did not develop AKI. Our study is the first pediatric study to show a substantial correlation between the variables associated with the PICU scoring modalities in critically ill children with AKI. Identifying the risk factors for the development of AKI and planning antimicrobial regimens for patients with favorable prognoses at the time of PICU admission could lower mortality rates.

Serum Ferritin and PELOD-2 Scores in Critically Ill Septic Children — a Cross-sectional Single-center Study

Serum Ferritin and PELOD-2 Scores in Critically Ill Septic Children — a Cross-sectional Single-center Study

706: OUTCOME COMPARISON OF INHALED ANESTHETICS VERSUS ECMO IN CHILDREN WITH NEAR-FATAL ASTHMA

Introduction: Extracorporeal Membrane Oxygenation (ECMO) and Inhaled Anesthetics (IA) are considered in the management of Near-Fatal Asthma (NFA) refractory to conventional therapy. We sought to compare these two modalities in children. Methods: This is a retrospective study using the Virtual Pediatric Systems Database, (VPS, LLC). We included patients < 18 years of age with NFA treated with IA and/or ECMO between January 2010 and December 2020. Primary outcome was survival to hospital discharge. Results: A total of 221 patients were included in the study; 149 (67%) received only ECMO, 62 (28%) received only IA and 10 (5%) patients received both. There was no difference in age, PIM3, PRISM3, PELOD scores, pre-intervention pH or pCO2 between the ECMO and lA groups. The ECMO group had lower pre-intervention PaO2 (60 vs 78mmHg, p < 0.001) and higher utilization of high frequency oscillatory ventilation compared to the IA cohort. Pre intervention heliox was used more frequently in the lA group (p < 0.001). There was no difference in survival to hospital discharge; 128/149 (86%) in ECMO and 57/62 (92%) in IA (p=0.38) cohorts. The ECMO group had longer duration of intervention (5 vs 1.3 days, p< 0.001), more frequent mid intervention cardiac arrest (7% vs 2%, p= 0.04), longer ICU length of stay (LOS) (13 vs 7 days p< 0.001) and required more bronchoscopies (34% vs 11% p< 0.001). Post-intervention mechanical ventilation was similar among survivors (p=0.38). Conclusions: In our study, ECMO and IA had comparable survival to hospital discharge. However, ECMO was associated with higher risk of complications and ICU LOS.

Mortality Assesment of Pediatric Septic Patients Through Pediatric Sofa+Anion Gap and Pelod-2 Scores

Highlight: Sepsis and septic shock cause morbidity and mortality in pediatric patients. The accuracy of pediatric sequential organ failure assessment and anion gap (pSOFA+AG) was compared with AG and pediatric logistic organ dysfunction-2 (AG+PELOD-2). The mortality assessment of pediatric septic patients showed that pSOFA was more sensitive than PELOD-2, while pSOFA+AG was not more sensitive than PELOD-2. Abstract: Sepsis and septic shock are some of the causes of morbidity and mortality (50-60%) in pediatric patients treated in intensive care rooms. This study aimed to compare the accuracy of pediatric Sequential Organ Failure Assessment (pSOFA) score combined with anion gap (AG) score to Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score in the assessment of mortality in pediatric septic patients at the Resuscitation Room of Dr. Soetomo Geeneral Academic Hospital, Surabaya, Indonesia. This was a retrospective observational cohort study using pediatric sepsis diagnosis guidelines based on the 2016 Pediatric Sepsis Consensus and medical records between January-December 2018. All data of patients aged 1 month to 16 years with suspected infection at the Resuscitation Room were collected based on predisposing infections, signs of infection, and warning signs. Organ dysfunction was assessed by calculating the pSOFA+AG scores, PELOD-2 scores, and corrected anion gap (cAG) in the first 24 hours. Sepsis mortality was assessed by comparing the results of the pSOFA, pSOFA+AG, and PELOD-2. The results showed 94.9% sensitivity and 70.0% specificity (p&lt;0.0001) in the pSOFA, 89.9% sensitivity and 71.3% specificity (p&lt;0.0001) in the PELOD-2, 79.7% sensitivity and 65% specificity (p&lt;0.0001) in the AG, 79.7% sensitivity and 73.8% specificity (p&lt;0.0001) in the cAG, and 79.3% sensitivity (p&lt;0.0001) in the pSOFA+AG. In conclusion, pSOFA was more sensitive than PELOD-2, while the use of pSOFA+AG was not more sensitive than PELOD-2 in assessing the mortality of pediatric septic patients.

Severity of illness and organ dysfunction scoring systems in pediatric critical care: The impacts on clinician's practices and the future.

Severity and organ dysfunction (OD) scores are increasingly used in pediatric intensive care units (PICU). Therefore, this review aims to provide 1/ an updated state-of-the-art of severity scoring systems and OD scores in pediatric critical care, which explains 2/ the performance measurement tools and the significance of each tool in clinical practice and provides 3/ the usefulness, limits, and impact on future scores in PICU. The following two pediatric systems have been proposed: the PRISMIV, is used to collect data between 2 h before PICU admission and the first 4 h after PICU admission; the PIM3, is used to collect data during the first hour after PICU admission. The PELOD-2 and SOFApediatric scores were the most common OD scores available. Scores used in the PICU should help clinicians answer the following three questions: 1/ Are the most severely ill patients dying in my service: a good discrimination allow us to interpret that there are the most severe patients who died in my service. 2/ Does the overall number of deaths observed in my department consistent with the severity of patients? The standard mortality ratio allow us to determine whether the total number of deaths observed in our service over a given period is in adequacy with the number of deaths predicted, by considering the severity of patients on admission? 3/ Does the number of deaths observed by severity level in my department consistent with the severity of patients? The calibration enabled us to determine whether the number of deaths observed according to the severity of patients at PICU admission in a department over a given period is in adequacy with the number of deaths predicted, according to the severity of the patients at PICU admission. These scoring systems are not interpretable at the patient level. Scoring systems are used to describe patients with PICU in research and evaluate the service's case mix and performance. Therefore, the prospect of automated data collection, which permits their calculation, facilitated by the computerization of services, is a necessity that manufacturers should consider.

Analysis of predictors of mortality and clinical outcomes of different subphenotypes for moderate-to-severe pediatric acute respiratory distress syndrome: A prospective single-center study.

This study aimed to observe the prognosis of patients with moderate-to-severe pediatric acute respiratory distress syndrome (PARDS) admitted to the Pediatric Intensive Care Unit (PICU) as a function of underlying conditions and available treatment strategies, and to investigate the risk factors for death and the outcomes of different clinical subphenotypes. Patients were divided into non-survivors and survivors according to the prognosis 28 days after the diagnosis. The risk factors for death and the predictive value of relevant factors for mortality were analyzed. Latent class analysis was used to identify different clinical subphenotypes. A total of 213 patients with moderate-to-severe PARDS were enrolled, of which 98 (46.0%) died. Higher PELOD2 scores (OR = 1.082, 95% CI 1.004-1.166, p < 0.05), greater organ failure (OR = 1.617, 95% CI 1.130-2.313, p < 0.05), sepsis (OR = 4.234, 95% CI 1.773-10.111, p < 0.05), any comorbidity (OR = 3.437, 95% CI 1.489-7.936, p < 0.05), and higher infiltration area grade (IAG) (OR = 1.980, 95% CI 1.028-3.813, p < 0.05) were associated with higher mortality. The combination of these five indicators had the largest area under the curve (sensitivity 89.79%, specificity 94.78%). Patients were classified into higher-risk and lower-risk phenotype group according to the latent class analysis. Compared to the lower-risk phenotype, more patients with higher-risk phenotype suffered from sepsis (24.40% vs. 12.20%, p < 0.05), inherited metabolic diseases (45.80% vs. 25.60%, p < 0.05), positive respiratory pathogens (48.10% vs. 26.80%, p < 0.05), and higher IAG (p < 0.05); they also had significantly higher PIM3 and PELOD2 scores (p < 0.05), with an extremely high mortality rate (61.1% vs. 22.0%, p < 0.05). Moderate-to-severe PARDS has high morbidity and mortality in PICU; a higher PELOD2 score, greater organ failure, sepsis, any comorbidity, and higher IAG were risk factors for death, and the combination of these five indicators had the greatest value in predicting prognosis. More patients with sepsis, positive respiratory pathogens, higher PIM3 and PELOD2 scores, and higher IAG were in higher-risk phenotype group, which had worse outcomes. Clear classification facilitates targeted treatment and prognosis determination.

Therapeutic plasma exchange application in the treatment of sepsis in a pediatric burn center

Objective: In our study, we aimed to analyze the use of Therapeutic plasma exchange (TPE) in the manage-ment of septic and Thrombocytopenia-associated multiple-organ failure (TAMOF) in the burn in-tensive care unit of a children’s hospital retrospectively. Material and Methods: Demographic, clinical, and laboratory data of the pediatric burn patients who were applied TPE between 1 January 2016 and 1 January 2021 were obtained from the hospital information system and medical records and analyzed. The patients were divided into two groups those who died du-ring follow-up and those who recovered. Results: TPE was performed on 14 burned children (Boy: Girl 5:9). The median age of the patients was 6,6 years (range 1-18 years). The mean TBSA of the patients was 47.76% (20-75). The most common cause of burns was flame burn. The mean hospital stay of the patients was 18.4±12.6 (7-94) days. 4 patients in group 1 recovered and 10 patients in group 2 died during follow-up. There was no statistical difference between the groups in terms of age, gender, and TBSA (p=0.590, 0.890, 0.990). We determined that patients in group 2 were statistically higher in terms of MODS (p=0.030), Pelod score (p=0.001), and expected death rate according to Pelod score (p=0.003). It was observed that the application of TPE in the first 24 hours after the occurrence of TAMOF significantly reduced mortality (p=0.010). Conclusion: TPE should be used as an additional treatment method to conventional therapy in critically ill pati-ents in pediatric burn intensive care units. TPE application in the first 24 hours after the occurrence of TAMOF reduces mortality.