PRISM Score Research Articles

Evaluation of patients undergoing therapeutic plasma exchange in the pediatric intensive care unit and determining the factors affecting prognosis.

Therapeutic plasma exchange (TPE), an extracorporeal method targeting the removal of large molecular weight pathogens, is explored in this study for indications, complications, prognosis, safety, and effectiveness. The patients' data were collected retrospectively. Overall, 334 sessions of TPE were applied to 57 patients. Per the American Society for Apheresis classification, 24.6% of indications fell under Category I, 14% Category II, and 50.9% Category III. Sepsis-induced multiorgan dysfunction syndrome (MODS) emerged as the leading indication, correlating with elevated needs for mechanical ventilation (MV), increased failed organs, and heightened mortality. Patients undergoing continuous renal replacement therapy faced a 16.06 times higher mortality risk. Non-survivors exhibited higher comorbidity, prolonged MV, increased inotropic drug requirement, more failed organs, and a higher PRISM score. 33.2% of complications occurred, primarily catheter-related. Sepsis-induced MODS and extracorporeal modalities are associated with increased mortality in TPE patients, with comorbidities, ventilation, and PRISM scores potentially influencing outcomes.

Multiple myeloma: retrospective assessment of routine thromboprophylaxis and utility of thrombotic risk scores

BackgroundThe high risk of venous thromboembolism (VTE) in multiple myeloma (MM) warrants primary thromboprophylaxis for most patients. Myeloma-specific thrombotic risk scores (TRSs), such as IMPEDE-VTE, SAVED, and PRISM, were developed to improve risk assessment and guide antithrombotic strategies. Their performance is variable and has not yet been tested in Latin America. ObjectivesWe aimed to assess the use of primary thromboprophylaxis, the incidence of VTE and bleeding events, and the effectiveness of TRSs in patients with newly diagnosed MM. MethodsThis was a retrospective, single-center study. Cumulative VTE rates and TRS performance were analyzed using survival and receiver operating characteristic curves. ResultsThe study included 250 newly diagnosed MM patients; the vast majority (98.6%) received aspirin as thromboprophylaxis. VTE occurred in 8% within the initial 6 months, increasing to 14.8% over a median follow-up of 19 months. High rates of major bleeding (4.8%) and clinically relevant nonmajor bleeding (4.4%) events were documented. A minimal proportion (0.8%, 0.5%, and 1.2%) of patients were classified as low risk by IMPEDE-VTE, PRISM, and SAVED scores, respectively. Only IMPEDE-VTE exhibited a trend for distinguishing between intermediate-risk (7.14%) and high-risk (13.2%) groups (P = .09). PRISM and SAVED scores showed limited utility. VTE did not impact survival. ConclusionAspirin as primary thromboprophylaxis carries an unacceptable risk of VTE and bleeding in patients at intermediate or high thrombotic risk. The IMPEDE-VTE score performed best, although without reaching statistical significance. We confirm that VTE does not portend poor overall survival in MM.

Comparison of Pediatric Risk of Mortality (PRISM III) score with Pediatric Index of Mortality (PIM III) score in Pediatric Intensive Care Unit: A Single center, prospective observational study from South India

Abstract Background: Pediatric risk of mortality (PRISM III) score and pediatric index of mortality (PIM III) scores are most recent versions of PRISM and PIM score used for mortality prediction in the Pediatric intensive care units (PICUs). This study aims to compare the performance of these two scores in children admitted to a tertiary PICU of South India. Subjects and Methods: This single-center, prospective observational study was conducted in PICU at a Tertiary Care Hospital in South India over a period of 20 months. A total of 214 cases admitted between the age groups of 1 month and 18 years were included in this study. PIM III and PRISM III scores were calculated. Quantitative correlation between the results of the score was analyzed by spearman test. Discrimination was assessed using the area under receiver operating characteristics curve and calibration using Hosmer–Lemeshow goodness-of-fit test. Results: Out of 214 children, observed mortality was 11 (5.1%). Estimated mortality using PRISM III and PIM III was 4 (1.86%) and 2 (0.93%), respectively. Although both scoring systems had good discrimination performance, PIM III score (0.934 [confidence interval (CI) 95%, 0.886–0.982]) had higher discrimination than PRISM III score(0.888 [CI 95%, 0.797–0.980]). PRISM III score (χ 2 = 4.469 and P = 0.484) had better calibration as compared to PIM III score (χ 2 = 16.093 and P = 0.041). Conclusions: Both PRISM III and PIM III score showed good discriminatory performance, however PRISM III had better calibration than PIM III score.

Neurodevelopmental Outcomes of Pediatric Cardiac Extracorporeal Membrane Oxygenation Survivors With Central Cannulation.

Extracorporeal life support, such as pediatric cardiac extracorporeal membrane oxygenation (ECMO), is associated with significant mortality and morbidity risk. This study evaluated cardiac ECMO survivors with central cannulation and found that 51.1% were discharged from the hospital. The study also revealed high rates of developmental delay (82.7%), motor dysfunction (58.8%), and cognitive dysfunction (70.6%) among survivors. No significant correlation was found between the duration of ECMO, age at ECMO, pre-ECMO maximum lactate levels, and cognitive scores. Participants with motor dysfunction were significantly younger (p = 0.04). PRISM scores of those with an abnormal developmental status were significantly higher (p = 0.03). Logistic regression analysis did not show a significantly increased risk. Factors such as age, disease severity, and ECMO itself were identified as potential contributors to neurodevelopmental delay.

Evaluation of Vitamin (A) Deficiency among Critically Ill Children with Sepsis

Abstract Background Vitamin A is an immunomodulatory, and its deficiency may cause impaired immune function, which are found in sepsis. There is a biological rationale that vitamin A deficiency (VAD) may be a contributing factor related to poor clinical outcomes in patients with sepsis. Aim of the Work to assess the prevalence of vitamin A deficiency in critically ill children with sepsis and its association with clinical outcomes. Patients and Methods This cross-sectional study included 40 critically ill children with sepsis who were admitted to the paediatric intensive care unit. The control group consisted of 40 age- and sex-matched approximate-health children from outpatient clinic. For the measurement of serum vitamin A status, blood samples were taken from all patients within the first 24 hours of admission. The vitamin A status of the sepsis and control groups were compared. Univariate and multivariate approaches were used to assess the link between vitamin A deficiency and sepsis. Results The study enrolled 40 children with sepsis and 40 matched healthy children so there was no statistically significant difference between controls and patients among age and sex, with median age 4 (2 – 12) months for both groups with male predominance (60.0%). Regarding body measures there was a high statistically significant lower values among patients group than controls group for z score of weight, height/length, body mass index (BMI) and mid arm circumference (MAC) of the studied subjects, that indicated increased malnutrition prevalence among septic children than control group. In the present study, by comparing VAD between patients and controls, there was high statistically significant difference as all septic patients (100%) had VAD and the VAD among healthy control was found in 30% of them. We also found that patients with septic shock, patients who were nothing per os (NPO), patients on ventilators and died patients were more deficient in vitamin A level than other patients compared with them (high statistically significant difference), illustrated that VAD may be had a role in sepsis related morbidity and mortality. There was a positive correlation between vitamin A and BMI z score and MAC while there was a negative correlation with prism 3 and prism 4.ROC curve for assessment of vitamin A as a predictor of sepsis, found that at cut off value ≤9 μg/dl, the Sensitivity, Specificity, positive predictive value (PPV) and negative predictive value (NPV) were 100% for each. Conclusion low level of vitamin A, lower than or equal to 9 μg/dl was associated with sepsis, septic shock, and higher PRISM score. Vitamin A deficiency may be a marker of morbidity and mortality in critically ill children with sepsis.

Association of EEG characteristics with outcomes following pediatric ICU cardiac arrest: A secondary analysis of the ICU-RESUScitation trial

Background and ObjectivesThere are limited tools available following cardiac arrest to prognosticate neurologic outcomes. Prior retrospective and single center studies have demonstrated early EEG features are associated with neurologic outcome. This study aimed to evaluate the prognostic value of EEG for pediatric in-hospital cardiac arrest (IHCA) in a prospective, multicenter study. MethodsThis cohort study is a secondary analysis of the ICU-Resuscitation trial, a multicenter randomized interventional trial conducted at 18 pediatric and pediatric cardiac ICUs in the United States. Patients who achieved return of circulation (ROC) and had post-ROC EEG monitoring were eligible for inclusion. Patients < 90 days old and those with pre-arrest Pediatric Cerebral Performance Category (PCPC) scores > 3 were excluded. EEG features of interest included EEG Background Category, and presence of focal abnormalities, sleep spindles, variability, reactivity, periodic and rhythmic patterns, and seizures. The primary outcome was survival to hospital discharge with favorable neurologic outcome. Associations between EEG features and outcomes were assessed with multivariable logistic regression. Prediction models with and without EEG Background Category were developed and receiver operator characteristic curves compared. ResultsOf the 1129 patients with an index cardiac arrest who achieved ROC in the parent study, 261 had EEG within 24 h of ROC, of which 151 were evaluable. The cohort included 57% males with a median age of 1.1 years (IQR 0.4, 6.8). EEG features including EEG Background Category, sleep spindles, variability, and reactivity were associated with survival with favorable outcome and survival, (all p < 0.001). The addition of EEG Background Category to clinical models including age category, illness category, PRISM score, duration of CPR, first documented rhythm, highest early post-arrest arterial lactate improved the prediction accuracy achieving an AUROC of 0.84 (CI 0.77–0.92), compared to AUROC of 0.76 (CI 0.67–0.85) (p = 0.005) without EEG Background Category. ConclusionThis multicenter study demonstrates the value of EEG, in the first 24 h following ROC, for predicting survival with favorable outcome after a pediatric IHCA.

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.

TURKISH VALIDITY AND RELIABILITY STUDY OF THE DEPRIVATION ASSESSMENT TOOL-1

Objective: No Turkish adaptation of a measurement tool evaluating the withdrawal in sedated children was found in the literature. This situation raised the need for a measuring instrument in the literature that assesses the withdrawal of children in Turkey. This study aimed to determine the Turkish validity and reliability of the Withdrawal Assessment Tool-1. Methods: It is a methodological study. The sample of the study consisted of 80 children, who were hospitalized in the 16-bed Pediatric Intensive Care Unit of a State hospital in Istanbul, who volunteered to participate in the study, and who had parental consent. The data were collected between 25.12.2020 and 22.08.2021, through “Descriptive Information Form”, “Withdrawal Assessment Tool-1”, “Pediatric Cerebral Performance Category Scale”, and “Pediatric Overall Performance Category” and “PRISM score”. The data obtained from the study were evaluated using SPSS 22.0 and MedCalc 19.1 statistical programs. Results: A significant positive (p=0.000

Tei Index and its Relation to Outcome of Critically Ill Children on Continuous Renal Replacement Therapy.

To evaluate echocardiographic parameters, especially the Tei index as a predictor of outcome in critically ill children on continuous renal replacement therapy (CRRT). This cohort study included all critically ill patients admitted at the Pediatric intensive care unit (PICU) and underwent CRRT. Functional echocardiography and Pediatric Risk of Mortality Index (PRISM) III were used to evaluate the participants. Both the Tei index and the Vasoactive inotropic score (VIS) were estimated. The study included 35 patients with an age range of 6 mo to 14 y. The Tei indexes, VIS, and PRISM III were reported as predictors of mortality with a sensitivity of 88%, 83%, and 94% and a specificity of 73%, 79%, and 89% respectively. In survivors, the mean Tei index score, median VIS, and mean PRISM values were 0.44 ± 0.1, 3.8 (0-40), and 12.06 ± 3.35, respectively. However, in non-survivors, the mean Tei index, median VIS, and mean PRISM score were 0.59 ± 0.16, 0.60 (0-342.5), and 22.94 ± 8.93, respectively. The Tei index could be used as a predictor for poor outcomes in children receiving CRRT. It is correlated to the PRISM score and VIS.

Clinical impact and efficacy of bedside echocardiography on patient management in pediatric intensive care unit: A single center study

BackgroundCritically ill pediatric patients often have multi-system involvement that can overlap different clinical diagnoses, making proper assessment and management challenging. Using echocardiography is increasing as a bedside and noninvasive tool for accurate hemodynamic assessment and guiding treatment. ObjectivesThis study aimed to determine the indication and value of bedside echocardiography in patient management in the pediatric intensive care unit (PICU) at Fayoum University Hospital and the relationship to the Pediatric Risk of Mortality Score III (PRISM). MethodsA total of 200 critically ill pediatric patients admitted to the PICUs of Fayoum University Hospital between January 2020 and January 2021 were prospectively evaluated. Detailed clinical examinations and requested echocardiography were conducted by intensivists and cardiologists. Results200 critically ill pediatric patients had an age range of 0.2–12 years, with 134 patients (67 %) under two years old. The most common admission diagnosis was pulmonary disease in 51 patients (26 %), followed by cardiac disease in 44 (22 %). The most common indication for echocardiography was left ventricle function assessment in 68 patients (34 %). Among the 108 patients (54 %) who underwent echocardiographic assessment, no difference in the management was found, while in the remaining 92 patients (46 %), supplemental information or decision help in management was obtained. There was a positive correlation between the effective value of echocardiography in the management of patients with primary cardiac disease (p-value = 0.001), shock (p-value = 0.001), and hypoxia (p-value = 0.009). Additionally, there was no correlation between the PRISM score and the effectiveness of echocardiographic assessment. ConclusionThe most common clinical indication for bedside echocardiography is assessing cardiac function. Echocardiography is an effective tool in PICU patient management, particularly in cases with primary cardiac disease, hypoxia, and shock, but its effectiveness does not increase according to the severity of the disease.

Phosphorus abnormalities in a paediatric intensive care unit in North India

Introduction: Critical illness triggers severe acute phase response which is associated with several metabolic derangements. Serum phosphorus level abnormalities are common among them and go unnoticed in sick children.Objectives: To determine the prevalence of phosphorus abnormalities in sick children admitted to the paediatric intensive care unit (PICU) and its association with various clinical outcomes.Method: We conducted a prospective, non-interventional study at a PICU in North India. During an 18-month period we investigated the incidence of phosphorus abnormalities in patients admitted to the PICU on admission and followed the course at day 3 and day 7 during their stay.Results: The prevalence of phosphorus level abnormalities was 44.2% on admission to PICU; 34.9% patients had hypophosphataemia while 9.3% had hyperphosphataemia. Hypophosphataemia was significantly associated with severe malnutrition (p=0.041) while hyperphosphataemia was associated with organ failure (p=&lt;0.001). Although the need for mechanical ventilation, duration of PICU stay and mortality were higher in hypophosphataemic patients and PRISM score was higher in hyperphosphataemic patients, these differences were not statistically significant. Changes in the baseline phosphorus levels after PICU stays of 3 days (p=0.346) and of 7 days (p=0.782) were not statistically significant.Conclusions: Phosphorus abnormalities were highly prevalent in ill children admitted in the PICU. Hypophosphatemia was more common and was significantly associated with severe malnutrition while hyperphosphatemia was significantly associated with organ failure.

External Validation of PRISM Score in Multiple Myeloma Patients in a Community Setting: A Retrospective Cohort Study

Background: Newly diagnosed Multiple Myeloma (MM) patients have a 10 to 20 times higher risk of developing venous thromboembolism (VTE) than the general population. The pathogenesis may involve several factors such as activation of procoagulant factors, acquired activated protein C resistance, and inflammation. In addition to the general risk factors for venous thromboembolism such as older age, immobility, and surgery, some MM treatment-related factors such as the use of immunomodulatory drug therapy and abnormal cytogenetics contribute to the increased risk. The PRISM score (Prior VTE, Race, IMiD, Surgery, Metaphase Cytogenetics) is a risk prediction tool for VTE in MM and was published in 2022. The score ranges from 0 to 18 and patients were stratified into three groups: low (0), intermediate (1-6), and high risk (≥ 7). Our primary objective was to assess the external validity of the PRISM score in our community hospital setting. Methods: All consecutive newly diagnosed MM treated at Saint Vincent Hospital from 1/1/2008 to 12/22/2022 were included in our analysis. Patients receiving therapeutic anticoagulation for other indications or a diagnosis of VTE within 6 months preceding the MM diagnosis were excluded. Variables were collected through a retrospective chart review during MM treatment initiation. Model discrimination was assessed by calculating the area under the receiver operating characteristic curve (AUROC). Logistic regression was used to calculate the odds ratio (OR) of VTE occurrence in the risk prediction model. Results: A total of 214 patients with newly diagnosed MM and available data on VTE occurrence were included. The median age of our cohort at treatment initiation was 74 years (range 31- 96). The median BMI was 27.8. 56% were male, and 44% were female. The mean PRISM score was 2.9, and 73% of MM were IgG/IgA subtype. IMiD-based induction regimen was used in 63 % of patients. A total of 24 patients (11.2%) were diagnosed with VTE after treatment initiation, of which 8 (3.7%) patients had a previous history of VTE. Prophylactic aspirin was used in 53.8% and abnormal metaphase cytogenetics was identified in 13% of MM cases. The median time to VTE from induction therapy was 4.8 months. The PRISM score was low in 116 patients, intermediate in 89, and high in 9 patients. The AUROC of the model was 0.759 (95% CI, 0.644-0.874) (1). The cumulative incidence of VTE at 6 months, 12 months, and more than 1 year was 6%, 7%, and 11.2% of the patients respectively. Each 1-point increase in the score was associated with a significantly higher chance of VTE occurrence in the model [ HR= 1.53, 95% CI (1.27-1.85), P&amp;lt;0.001]. Among the parameters, patients with a history of VTE [ HR= 1.55, 95% CI (1.26-1.91), P&amp;lt;0.001] and with abnormal metaphase cytogenetics [HR= 2.35, 95% CI (1.37-4.05), P&amp;lt;0.001] had a higher strength of association with the development of VTE after induction (2). Furthermore, among 9 patients with a high-risk PRISM score (≥ 7), 7 (77%) developed VTE within the first 6 months after treatment initiation. Conclusions: Our findings suggest that PRISM [AUROC=0.75, 95% CI (0.644-0.874), P&amp;lt;0.001] score could statistically predict VTE outcomes in our patient population. Abnormal metaphase cytogenetics was a significant predictor of VTE in the validation cohort. Abnormal cytogenetics has been well established to be an indicator of aggressive tumor biology and proliferation in stroma-independent MM. It has been established to be a predictor of VTE in acute myeloid leukemia as well. Also, high-risk scores were predictive of earlier development of VTE after treatment induction. Our study strengthens the evidence of using PRISM as a predictive tool. Further studies are needed to enhance the sensitivity of our existing tool.

Peripheral vascular access as exclusive access mode in pediatric intensive care unit.

The type of vascular access (central or peripheral) in pediatric critical care depends on several factors, including the duration of treatment, the properties of the medication (osmolarity or vesicant), and the need for central pressure monitoring. The utilization of peripheral intravascular catheters (PIVCs) has shown a notable increase in the number of patients being treated. Extended dwell or midline catheters are another peripheral access option in addition to PIVCs. However, there are currently no established guidelines on their placement. The aim of this study is to estimate the duration of dwell time for PIVCs, analyze the specific parameters affecting it, and develop recommendations for switching to extended dwell and midline catheter placement as an alternative to peripheral access. The study enrolled patients aged 0-18 years admitted to the pediatric intensive care unit (PICU) for over 24 h and managed with peripheral access only over 2 years (2019-2021). A total of 484 patients met the specified criteria. Patients who had peripheral access exhibited a lower PRISM score and a shorter length of stay in the PICU, with mean values of 18 (SD: 8.5) and 9.5 (SD: 6.4) days, respectively, compared with patients who had central access with mean values of 8.9 (SD: 5.9) and 5.7 (SD: 3.6) days, respectively. The PIVC dwell time was found to be 50.1 h (SD: 65.3) and required an average of 1.6 insertion attempts. Patients with three or more insertions exhibited an increased odds ratio of 5.2 (95% CI: 3.1-8.5) for receiving an extended dwell or midline insertion. Increased dwell time was associated with female gender, 59.5 h (P < 0.001), first attempt insertion, 53.5 h (P < 0.001), use of 24 Ga bore, 56.3 h (P = 0.04), left-sided insertions, 54.9 (P = 0.07), less agitation, 54.8 h (P = 0.02), and less edema, 61.6 (P < 0.001). Decreased dwell time was associated with the use of vancomycin infusion at 24.2 h (P < 0.001) and blood transfusions at 29.3 h (P < 0.001). Extended catheters last longer than PIVCs in PICU patients. Extended catheter placement requires consideration of the length of treatment, as well as the overall body edema, the level of the patient's restlessness, and the need for vancomycin infusion or blood transfusions, as these factors reduce PIVC dwell time and expose the patients to painful insertions. For such cases, an extended dwell catheter may be a better option, even if the projected treatment time is less than 6 days.

Incidence of new morbidity in children on discharge from pediatric intensive care unit of a developing country.

Objective: To determine the incidence of newly acquired morbidity, its categorization, and to identify the associated risk factors among children upon being discharged from the PICU. Study Design: Prospective Longitudinal Cohort study. Setting: Multidisciplinary PICU of Aga Khan University Hospital. Period: October 2022 to March 2023. Material &amp; Methods: Patients who were readmitted to the PICU, deceased, or lost to follow-up during the study were excluded. The functional status was assessed using FSS at baseline, PICU discharge, and at 3 months to measure newly acquired morbidity and dysfunction. All data was collected on a structured proforma. Categorical variables were presented as absolute values and percentages, and continuous variables were expressed as means ± SD or medians with interquartile range or proportions as applicable and considered statistically significant level if p value is ≤ 0.05. Results: A total 96 patients were discharged alive from PICU and 85 of them were included in this study. The mean age was 5.27 ± 5.01 years. The major diagnostic categories were acute respiratory illnesses (25.89%), cardiovascular disorders (21.18%), and neurological disorders (16.47%). 43.53% of the patients underwent surgical intervention. The mean PRISM score at admission was 4.32 ± 5.84. The incidence of morbidity was 40% (34/85) at PICU discharge and 5.8% at 3 months. Longer duration of vasoactive medications, arterial catheterization, mechanical ventilation and PICU stay were associated with new morbidity in critically ill children on discharge from PICU. Conclusion: At PICU discharge, the incidence of new morbidity among critically ill pediatric patients was 40%, which reduced to 5.8% at 3 months. Patients with hemodynamic instability, longer duration of inotropic support and those on prolonged mechanical ventilation had longer PICU stay and exhibited increased risk for new morbidity development. The majority of patients (&gt;82%) exhibited either good functional status or mild dysfunction upon discharge.

External validation of venous thromboembolism risk prediction models in patients with multiple myeloma in a community setting: A retrospective cohort study.

e20027 Background: Newly diagnosed Multiple Myeloma (MM) patients have a 10 to 20 times higher risk of developing venous thromboembolism (VTE) than the general population. Three risk prediction models have been recently established to ascertain the degree of VTE risk: SAVED (Surgery, Asian race, VTE history, Elderly and Dexamethasone), IMPEDE VTE (Immunomodulatory drugs (IMiD), BMI, Pelvic fracture, Erythropoietin stimulating agent, Dexamethasone/Doxorubicin, Asian Ethnicity, VTE history, Tunneled line, Existing thromboprophylaxis) and PRISM scores (Prior VTE, Race, IMiD, Surgery, Metaphase Cytogenetics). Our primary objective was to assess the external validity of three VTE risk prediction models in a community hospital setting. Methods: All consecutive newly diagnosed MM treated at Saint Vincent Hospital from 1/1/2012 to 12/22/2022 were included in our analysis. Patients receiving therapeutic anticoagulation for other indications or a diagnosis of VTE within 6 months prior to MM diagnosis were excluded. Variables were collected by retrospective chart review at the time of MM treatment initiation. Model discrimination was assessed by calculating the area under the receiver operating characteristic curve (AUROC). Logistic regression was used to calculate the odds ratio (OR) of VTE occurrence with candidate variables in the risk prediction model. Results: The 160 patients with newly diagnosed MM and available data on VTE occurrence were included. The median age of our cohort at treatment initiation was 74 years (range 31-96); 55% were male, and 75% were Caucasians. IMiD-based induction regimen was used in 68.1 % of patients. The median SAVED score was 1 (IQR:0-2), IMPEDE VTE was 4 (IQR: 2-6), and PRISM score was 2 (IQR: 0-2). The most common thromboprophylactic agent used was aspirin (53.8%). The median time to VTE from induction was 4.8 months. The cumulative incidence of VTE at 12 months was 13.1%. Each 1-point increase in the score was associated with a significantly higher chance of VTE occurrence across all three models (Table). Factors significantly associated with the development of VTE were prior VTE history (OR:2.28, 95% CI:1.31-3.97,p = 0.003) and age greater than 80 years (OR:4.03, 95% CI:1.47-11.02,p = 0.006). Conclusions: Our findings suggest that all three PRISM (AUROC = 0.70), SAVED (AUROC = 0.72), and IMPEDE VTE (AUROC = 0.73) scores could statistically predict VTE outcomes in our patient population. The inclusion of more parameters in the IMPEDE VTE score may have led to its outperformance in risk stratification. [Table: see text]

Prognostic significance of serum pro-calcitonin level in paediatric intensive care unit patients

Background: Serum procalcitonin (PCT) is already known predictive marker in serious bacterial infection and it is emphasized that these biomarkers can be used as a marker of increased mortality in critically ill patients. The aim of the study was to evaluate the serial PCT level and find out whether these biomarkers can be used to predict mortality. Methods: This was a prospective observational study. Primary objective was to study the serum PCT as a prognostic marker in critically ill children (2 months to 12 years) admitted in PICU while secondary objective was to find out the association of level of serum procalcitonin with different organ system disease involvement and to compare the results of the serum procalcitonin with the PRISM-3 score in diagnosing the severity of illness in the patient. Patient outcome was assessed at hospital discharge, and the patients were divided into non-survivors and survivors. A p value of &lt;0.05 will be considered statistically significant. Results: A total of 185 patients were enrolled, the median age was 5 years (2 months to 12 years) with 56.76% being males. Majority (34.59%) of patients the primary diagnosis was of respiratory system. The median of serum PCT on day 1, day 3 and day 7 with outcome (p&lt;0.05) in dead was significantly higher as compared to alive. The median PRISM score in dead was 21(13-33) which was significantly higher as compared to alive 11 (8-12.7). Serum PCT and PRISM score had significant discriminatory power to predict mortality. Conclusions: In the present study serum PCT found to be a good prognostic marker for all cause mortality in critically ill patients admitted in PICU.

Data, Anomalies; a Call to Cease and Desist.

Data, Anomalies; a Call to Cease and Desist.

1132: MAKING PRISM EASY: DEVELOPMENT OF A STATA COMMAND FOR RISK-OF-MORTALITY CALCULATION

Introduction: PRISM scores have been used in pediatric research to estimate mortality risk and control for illness severity. A major barrier to the usage of this score is the complexity of the calculation and the lack of publicly available implementations. The single publicly available calculator is inconsistently accurate depending on units used and supports data entry for only one patient at a time. Usage of the score over large datasets requires developing custom code to assign scores to physiological variables and calculate the probability of mortality, a resource-intensive and error-prone process. Custom implementations duplicate efforts and are not guaranteed to be accurate. Here we describe the development of a STATA command that calculates PRISM III and PRISM IV scores. Methods: A STATA command that performs PRISM III and PRISM IV score calculations was developed on STATA/MP 17.0. The command implemented the scoring described in the original papers while adding robust error-proofing, data validation, the ability to use both SI and US laboratory value units, and a graphical user interface. Command validation was accomplished by performing unit tests and calculating scores based on deidentified data. Spot checks were performed to ensure the accuracy of the calculations. The command was additionally tested by generating datasets of 10,000,000 simulated patient records containing random realistic data with predetermined PRISM scores and comparing the command output with the predetermined score. To test the run-time of the command, the command was run over 5 distinct datasets using STATA/MP 17.0 2-cores. Results: The STATA command achieved 100% accuracy on both the spot checks and the generated data. The median run-time for PRISM III calculations over 10,000,000 simulated patient records is 50.48 seconds (IQR 46.74 - 50.83). The median run-time for PRISM IV calculations over 10,000,000 simulated patient records is 51.52 seconds (IQR 50.46 - 53.44). Conclusions: The prismscore STATA command performs PRISM III and PRISM IV calculations accurately and efficiently over datasets of all sizes. The tool improves the reproducibility of research involving the scores, streamlines data analysis for pediatric critical care datasets, and offers significant time and resource savings to the research community.

Mitigating the risk of venous thromboembolism in patients with multiple myeloma receiving immunomodulatory-based therapy

Patients with multiple myeloma (MM) have up to a 20-fold increased risk of venous thromboembolism (VTE) compared with the general population, with most events occurring within the first 6 months of diagnosis. Treatment with immunomodulatory drugs (IMiDs) is a strong risk factor for VTE in MM. In a meta-analysis of 2 large, randomized trials comparing anticoagulant thromboprophylaxis vs placebo in ambulatory patients with cancer at high risk of VTE based on a validated risk score, the risk of VTE decreased without increasing the risk of major bleeding. However, few patients with MM participated in these trials (1.1%). Initial guidance for risk-stratifying patients with MM resulted in persistent rates of VTE >10% and highlighted the need for improved VTE risk stratification in patients with MM. Three validated risk scores are now available to quantify risk of VTE in patients with MM: SAVED, IMPEDE VTE, and PRISM scores. Using best available data, thromboprophylaxis should be strongly considered in patients with MM assessed as high risk for VTE, especially newly diagnosed patients receiving IMiD-based combination therapies. However, prospective studies are needed to further validate available models and identify the optimal thromboprophylactic agent for each VTE risk category.

Sepsis associated acute kidney injury in pediatric intensive care unit.

We aimed to compare the acute kidney injury (AKI) incidence in pediatric septic shock patients according to the three different classifications. We analyzed retrospectively 52 patients with severe sepsis between January 2019 and December 2019. While 21 patients have been diagnosed with SA-AKI according to the pRIFLE criteria, 20 children have been diagnosed according to the AKIN criteria, and 21 children have been diagnosed according to the KDIGO criteria. Older age, lower platelet count were determined as independently risk factor for SA-AKI. Older age and higher PRISM score were associated with mortality. According to Canonical correlation coefficients, pRIFLE is the most successful classification to distinguish AKI state. The canonical correlation coefficients for pRIFLE, KDIGO, and AKIN were 0.817, 0.648, and 0.615, respectively. Although AKI incidence was similar between the three classifications, pRIFLE was the most successful classification to distinguish AKI state.