| Objective:In February 2016,experts from the American Society of Critical Illness?SCCM?and European Society of Critical Illness?ESICM?jointly proposed a new definition and diagnostic criteria for Sepsis 3.0 to meet the sequential organ failure score?SOFA?of patients with or suspected infection.Sepsis is diagnosed at?2 points[1].However,the consensus does not clarify the pediatric SOFA?pSOFA?scoring criteria and the sepsis diagnostic criteria for children based on SOFA.Can the pediatric version of the SOFA scoring?pSOFA?based on different child ages be used for new sepsis judgment of organ dysfunction in the definition,or how much pSOFA exceeds can be judged as"life-threatening organ dysfunction"are issues that need to be resolved,which is of great significance for the establishment of diagnostic criteria for sepsis in children in the future.The value of pSOFA score in the Pediatric Intensive Care Unit?PICU?of Shengjing Hospital Affiliated to China Medical University for children with or suspected infection in the prognosis of infected patients and its potential significance in the diagnosis of sepsis in children.Methods:A retrospective analysis was performed on children with infections or suspected infections who were admitted to our PICU from January 1,2018 to December 31,2018.Within 24 hours after admission of PICU based on pSOFA scores and Systemic Inflammatory Response Synthesis?SIRS?the worst physical examination and biochemical indicators were analyzed,all data were from the hospital's electronic case database.Prognostic outcomes refer to hospital mortality.By comparison the several severe scores and the area under the receiver operating characteristic curve?AUROC?assessed the value of pSOFA in the prognosis of infected patients.Results:A total of 218 children met the 2005 International Childhood Sepsis and Septic Shock Diagnosis and Treatment Experts"Consensus"diagnostic criteria for sepsis,138 children who meet the pSOFA score.Among them,the median value of the pSOFA score of the non-survivors who met the pSOFA score and the pSOFA score of the survivors were?4 points,2 points,P<0.01?.PSOFA score 2 points,3,4,5-6 and 7 to 9 points in hospital mortality are 8.97%,15.38%,26.09%,57.34%and100%,subgroup analysis of pSOFA for non-survivors mortality increased gradually with increasing pSOFA scor SIRS score 2 points;three points and four points of hospital mortality of 3.34%,12.64%and 4.76%respectively.pSOFA score and modified pediatric multiple organ failure score?P-MODS score?[2],pediatric organ function The correlation coefficient and 95%confidence interval of the Logistic-2score?P ELOD-2?[3]and the critical illness score[4]for children are?0.29?0.12,0.44?,P<0.01;0.28?0.12,0.43?,P<0.01;-0.25?-0.41,-0.09?,P<0.01?.The area under the receiver operating characteristic curve?AUROC?is analyzed as follows.The AUROC and 95%confidence interval of the pSOFA score are 0.74?0.62,0.86?P<0.01;AUROC and 95%confidence interval of P-MODS score is 0.68?0.55,0.81?P<0.01;AUROC and 95%confidence interval of PELOD-2 score is 0.63?0.49,0.77?P<0.05;AUROC and 95%confidence interval for critically ill children's scores are 0.73?0.62,0.84?P<0.01.AUROC and 95%confidence interval for SIRS are 0.62?0.49,0.74?)P=0.1256.According to the critical value of Youden index to determine the best of 4points.The survivor group and non-survivor group were in platelet?PLT?,C-reactive protein?CRP?,interleukin-6?IL-6?,lactic acid,D-dimer,pSOFA,P-MODS.The scores,PELOD-2 scores and pediatric critical case scores were statistically significant?P<0.05?.Conclusions:The pSOFA score was compared with the SIRS,P-MODS score,PELOD-2 score,and pediatric critical case scores in comparison with the pSOFA score.Higher accuracy in predicting the hospital mortality of children admitted to PICU.PSOFA score of 4 points is the best threshold in hospital mortality. |
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