Value of three scoring systems in evaluating the prognosis of children with severe sepsis

Abstract:

Objective To study the predictive value of Pediatric Age-adapted Sequential Organ Failure Assessment Score (pSOFA), Pediatric Risk of Mortality Score Ⅲ (PRISM Ⅲ), and Pediatric Critical Illness Score (PCIS) in children with severe sepsis. Methods A retrospective analysis was performed for the clinical data of 193 hospitalized children with severe sepsis. According to the final outcome, these children were divided into a survival group with 151 children and a death group with 42 children. The scores of pSOFA, PRISM Ⅲ, and PCIS were determined according to the worst values of each index within 24 hours after admission. The receiver operating characteristic (ROC) curve was used to analyze the efficiency of each scoring system in predicting the risk of death due to sepsis. Smooth curve fitting was used to analyze the correlation between the three scoring systems and the threshold effect of each scoring system. Decision curve analysis (DCA) was used to evaluate the application value of each scoring system. Results The ROC analysis showed that PCIS and pSOFA had a similar predictive value (P=0.182) and that PRISM Ⅲ and pSOFA had a similar predictive value (P=0.210), while PRISM Ⅲ had a better predictive value than PCIS (P=0.045). PRISM Ⅲ had the highest degree of fitting with prognosis, followed by pSOFA and PCIS. The DCA analysis showed that when the risk of death was 0.4 and 0.6 in children with severe sepsis and the three scoring systems were used as the basis for emergency intervention decision-making, pSOFA achieved the highest standardized net benefit, followed by PRISM Ⅲ and PCIS. Conclusions All three scoring systems have a certain value in predicting the prognosis of children with severe sepsis, and pSOFA has a better value than PRISM Ⅲ and PCIS.