Supplementary Material
Prognostic Accuracy of age-adapted SOFA, SIRS, PELOD-2, and qSOFA for In-Hospital Mortality Among Children With Suspected Infection Admitted to the Intensive Care Unit
Luregn J Schlapbach1,2,3, Lahn Straney4, Rinaldo Bellomo5,6, Graeme MacLaren7,8, David Pilcher9,10,11
1Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, Australia
2Paediatric Intensive Care Unit, Lady Cilento Children’s Hospital, Brisbane, Australia
3Department of Pediatrics,Inselspital, Bern University Hospital, University of Bern, Switzerland
4Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
5University of Melbourne, Melbourne, Australia
6Intensive Care, Austin Health, Melbourne, Australia
7Cardiothoracic Intensive Care Unit, National University Health System, Singapore, Singapore
8Paediatric Intensive Care Unit, The Royal Children’s Hospital, Melbourne, Australia
9The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE), ANZICS House, Levers Terrace, Carlton South, Melbourne, Australia
10Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
11Department of Intensive Care, The Alfred Hospital, Commercial Road, Prahran, VIC, Australia
METHODS
Study population:
We performed a multicenter binational cohort study of patients below 18 years admitted to an ICU in Australia and New Zealand using the Australian and New Zealand Intensive Care Society (ANZICS) Database. The study was approved by the Human Research and Ethics Committee (Mater Health Service, Brisbane, Australia). Patients were eligible if they had presence of suspected or proven infection at admission to ICU. We searched the final diagnosis of all records of ICU admission between 1.1.2000 and 31.12.2016 for inclusion in the study. The ANZICS Adult Patient Database is one of four clinical quality registries run by the Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation andis a prospective registry capturing patient demographics, severity, disease codes, and treatment interventions1. The database is maintained by the ANZICS Centre for Outcome and Resource Evaluation and captures more than 90% of all ICU admissions in Australia and New Zealand, with mandatory site-specific training and centralized monitoring and validation performed.
For patients that were transferred to another pediatric ICU (PICU), cases were followed through the Australian and New Zealand Paediatric Intensive Care Registry, using matching by date of interhospital transfer, unit location, age, sex, post code and diagnosis. We excluded repeated ICU admissions from the same hospital episode and patients transferred to another ICU facility whose outcome remained unknown.
The ANZICS APD hasbeenprospectivelycollectingdata on SIRS, APACHE and SOFA score in patientsadmittedtothecontributingunits. The ANZICS APD requireseachpatienttobegiven a singlediagnosiswhichrepresentsthecauseoftheadmissionto ICU. Childrenadmittedto adult ICUs had a diagnosisselectedfromthelistavailable in the APD. Diagnosticcodesrepresent a modificationofthe APACHE III diagnosticsystem. Instructionsforselectionofdiagnoseshavebeenprospectivelyprovided in the ANZICS Adult Patient Database Data Dictionary. Compliance withthisisachievedthroughprovisionofregulartrainingtodatacollectorsandclinicians, on siteauditsand ad hoc advicetodatacollectorsprovidedbystaff at ANZICS.
Outcomes and definitions:
In-hospital mortality was defined as primary outcome. Aligned with the Sepsis-3 development and validation cohorts, the composite secondary outcome was defined as in-hospital mortality or ICU length of stay of 3 days or longer.
Physiological severity parameters on cardiorespiratory, neurologic, hepatic, renal and hematological organ dysfunction were prospectively recorded in the study database capturing the highest and lowest value recorded during the first 24 hours of ICU admission. SIRS criteria, Pediatric Logistic Organ Dysfunction Score-2 (PELOD-2), SOFA, and qSOFA were calculated based on the worst parameter captured during the first 24 hours of ICU admission (Supplementary Table 1). Age-specific cut-offs to define SIRS criteria (Temperature, heart rate, respiratory rate, white cell count (WCC); with 0 (best) to 4 (worst)) were applied as per the 2005 Pediatric Sepsis Consensus statement, and pediatric SIRS was defined as presence of ≥2 SIRS criteria one of which must be abnormal temperature or WCC. PELOD-2 represents the closest organ dysfunction score in comparison to SOFA, and has been developed and validated in pediatric ICU patients. All PELOD-2 items, except for pupillary dilatation and serum lactate levels were available in the database to allow to calculate a PELOD-2 ranging from zero (best) to 22 (worst). Given the absence of age-specific SOFA definitions, we developed an age-adapted SOFA by defining increasing severity of cardiovascular and renal dysfunction using the PELOD-2 cut-offs for mean arterial blood pressure and serum creatinine increase. In accordance with Singer et al, qSOFA was defined as a score composed of three binary variables (tachypnea, altered mentation, hypotension). In order to establish age-specific qSOFA scores, tachypnea and hypotension were defined by applying age-specific cut-offs for respiratory rate, and systolic blood pressure, respectively, as per the 2005 Pediatric Sepsis definitions and the correction provided in a subsequent author`s reply2,3. Altered mentation was defined as a Glasgow Coma Scale (range 3 (worst) to 15 (best)) of 14 or less.
Where individual components of SIRS criteria, SOFA, PELOD-2 and qSOFA were missing, a normal value for that component was imputed4. We assumed a baseline pre-ICU SOFA and PELOD-2 score of 0 in all patients. Where all components were unknown, the patient was assigned a missing score, and excluded from the primary analysis.
Statistics:
Data are presented as percentages and numbers or means with standard deviation. T-tests were used to compare normally distributed data, Wilcoxon rank-sum tests for skewed data and χ2 tests for categorical data by subgroups. Mixed effects logistic regression models were used to measure the association between the primary and secondary outcomes and the different scores. We measured the discrimination of each score using the area under the receiver operating characteristic curve (or C-statistic). The sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) was calculated for each score. A baseline risk model was developed to reflect the underlying risk of a patient developing the primary and secondary outcomes using available information at the time of ICU admission not contained in any of the scores. Univariate mixed effects logistic regression models, with a random effect for each site, were used to assess associations between patient factors and the primary outcome. Variables with associations p<0.2 where considered for inclusion in a multivariable model. Age group, major comorbidities, center, and presence of active treatment limitation remained in the final model. The same model was applied to the analysis of secondary outcome. For each model, the linear prediction of the fixed effects was used to adjust for baseline risk and calculate an adjusted AUC (C-statistic) for each score.
Sensitivity analyses were performed by using age- and sex-specific systolic blood pressure cut-offs based on the 5th percentile previously validated in children with sepsis5,6, and by using systolic blood pressure cut-offs used to define arterial hypotension in the corrected 2005 consensus definition2,3 Analyses were conducted using Stata (version 14.0, Stata Corp, College Station, Texas, USA). P-values <0.05 were considered significant.
Supplementary Table 1: Definitions to construct age-adapted scores for SIRS, severe sepsis, age-adapted SOFA, PELOD-2, and qSOFA.
A)SystemicInflammatory Response Syndrome (SIRS)Age Group / Heart Rate / Respiratory Rate / Leukocyte Count / Temperature
<2 years / <90 or >180 / >34 / >17.5 or >5 / <36 or >38.5
2 to 5 yrs / >140 / >22 / >15.5 or <6 / <36 or >38.5
>5 to 12 yrs / >130 / >18 / >13.5 or <4.5 / <36 or >38.5
>12 to <18 yrs / >110 / >14 / >11 or <4.5 / <36 or >38.5
Reference:
Goldstein B, Giroir B, Randolph A. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6(1):2-8.
B)Severe SepsisSevere sepsis= Infection plus Systemic Inflammatory Response Syndrome (SIRS) plus
-Cardiovascular organ dysfunction OR
-Respiratory organ dysfunction OR
-≥2 of organ dysfunctions other than cardiovascular or respiratory (renal, hepatic, haematologic, neurological)
Organ dysfunctionSystem / Parameter / 0 / 1
Respiration: any of the following / PaO2/FiO2 (mmHg) / ≥300 / <300
PaCO2 (mmHg) / ≤65 / >65
Invasive ventilation / No / Yes
Non-Invasive ventilation / No / Yes
Cardiovascular / Systolic arterial pressure
<2 years / ≥75 / <75
2 to 5 yrs / ≥74 / <74
>5 to 12 yrs / ≥83 / <83
12 to <18 yrs / ≥90 / <90
Renal / Creatinine
<2 years / ≤34 / >34
2 to 5 yrs / ≤50 / >50
5 to 12 yrs / ≤58 / >58
12 to <18 yrs / ≤92 / >92
Hepatic / Bilirubin (umol/l) / <20 / ≥20
Haematologic / Platelets (x10(9)/L) / ≥80 / <80
Central nervous system / Glasgow coma scale / ≥12 / <12
References:
Goldstein et al PediatrCrit Care Med. 2005;6(4):500; authorreply 500-1
Goldstein B, Giroir B, Randolph A. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6(1):2-8.
C)Age-adaptedSequential Organ FailureAssessment Score (SOFA)Score
System / Parameter / 0 / 1 / 2 / 3 / 4
Respiration / PaO2/FiO2 (mmHg) / ≥400 / <400 / <300 / <200 with
respiratory support / <100 with
respiratory support
Coagulation / Platelets x10(3)/uL / ≥150 / <150 / <100 / <50 / <20
Liver / Bilirubin (umol/l) / <20 / 20-32 / 33-101 / 102-204 / >204
Central nervous system / Glasgow coma scale / 15 / 13-14 / 10-12 / 6-9 / <6
Cardiovascular / Mean arterial pressure
<2 years / ≥60 / 44-59 / 31-43 / ≤30
2 to 5 yrs / ≥62 / 46-61 / 32-44 / ≤31
>5 to 12 yrs / ≥65 / 49-64 / 36-48 / ≤35
>12 to <18 yrs / ≥67 / 52-66 / 38-51 / ≤37
Renal / Creatinine
<2 years / ≤34 / ≥35
2 to 5 yrs / ≤50 / ≥51
>5 to 12 yrs / ≤58 / ≥59
>12 to <18 yrs / ≤92 / ≥93
Alternate SOFA model using Systolic blood pressure based on Goldstein et al (5th percentile 2005 Consensus definition, as defined in the author`s reply letter in PCCM 2005)
Cardiovascular / Systolic blood pressure / 0 / 1 / 2 / 3 / 4
<2 years / ≥75 / <75
2 to 5 yrs / ≥74 / <74
>5 to 12 yrs / ≥83 / <83
>12 to <18 yrs / ≥90 / <90
Alternate SOFA model using Systolic blood pressure based on 5th percentile cutoff (Hacque/Brain Trauma Foundation)
Cardiovascular / Systolic blood pressure / 0 / 1 / 2 / 3 / 4
<2 years / ≥ 67 (M), ≥ 68 (F) / < 67 (M), < 68 (F)
>2 to <3 years / ≥ 70 (M), ≥ 71 (F) / < 70 (M), < 71 (F)
>3 to <4 years / ≥ 73 (M), ≥ 71 (F) / < 73 (M), < 71 (F)
>4 to <5 years / ≥ 75 (M), ≥ 74 (F) / < 75 (M), < 74 (F)
>5 to <6 years / ≥ 78 (M), ≥ 76 (F) / < 78 (M), < 76 (F)
>6 to <7 years / ≥ 78 (M), ≥ 78 (F) / < 78 (M), < 78 (F)
>7 to <8 years / ≥ 79 (M), ≥ 78 (F) / < 79 (M), < 78 (F)
>8 to <9 years / ≥ 82 (M), ≥ 81 (F) / < 82 (M), < 81 (F)
>9 to <10 years / ≥ 82 (M), ≥ 83 (F) / < 82 (M), < 83 (F)
>10 to <11 years / ≥ 85 (M), ≥ 85 (F) / < 85 (M), < 85 (F)
>11 to <12 years / ≥ 87 (M), ≥ 85 (F) / < 87 (M), < 85 (F)
>12 to <13 years / ≥ 89 (M), ≥ 87 (F) / < 89 (M), < 87 (F)
>13 to <14 years / ≥ 90 (M), ≥ 90 (F) / < 90 (M), < 90 (F)
>14 to <15 years / ≥ 94 (M), ≥ 92 (F) / < 94 (M), < 92 (F)
>15 to <16 years / ≥ 95 (M), ≥ 93 (F) / < 95 (M), < 93 (F)
References:
Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810.
Leteurtre S, Duhamel A, Salleron J, et al. PELOD-2: an update of the PEdiatric logistic organ dysfunction score. Crit Care Med. 2013;41(7):1761-1773.
Goldstein B, Giroir B, Randolph A. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6(1):2-8; and PediatrCrit Care Med. 2005 Jul;6(4):500; author reply 500-1.
Haque IU, Zaritsky AL. Analysis of the evidence for the lower limit of systolic and mean arterial pressure in children. Pediatr Crit Care Med. 2007;8(2):138-144.
Schlapbach LJ, MacLaren G, Festa M, et al. Prediction of pediatric sepsis mortality within 1 h of intensive care admission. Intensive Care Med. 2017;43(8):1085-1096.
PediatricLogistic Organ Dysfunction Score-2 (PELOD-2)Score
0 / 1 / 2 / 3 / 4 / 5 / 6
Central nervous system / Glasgow coma scale / 15 / 13-14 / 10-12 / 6-9 / <6
Cardiovascular / Mean arterial pressure
<2 years / ≥60 / 44-59 / 31-43 / ≤30
2 to 5 yrs / ≥62 / 46-61 / 32-44 / ≤31
>5 to 12 yrs / ≥65 / 49-64 / 36-48 / ≤35
>12 to <18 yrs / ≥67 / 52-66 / 38-51 / ≤37
Renal / Creatinine
<2 years / ≤34 / ≥35
2 to 5 yrs / ≤50 / ≥51
>5 to 12 yrs / ≤58 / ≥59
>12 to <18 yrs / ≤92 / ≥93
Respiration / PaO2/FiO2 (mmHg) / ≥61 / <60
PaCO2 (mmHg) / ≤58 / 59-94 / ≥95
Invasive ventilation / No / Yes
Hematologic / White cell count (x10(9)/L / >2 / ≤2
Platelets (x10(9)/L / >142 / 77-141 / ≤76
References:
Leteurtre S, Duhamel A, Salleron J, et al. PELOD-2: an update of the PEdiatric logistic organ dysfunction score. Crit Care Med. 2013;41(7):1761-1773.
D)Pediatricage-adapted quick SOFA (qSOFA)Parameter
Score
Tachypnea / Definition / 0 / 1
Respiratory Rate / <2 years / ≥34 / >34
2 to 5 yrs / ≥22 / >22
>5 to 12 yrs / ≥18 / >18
12 to <18 yrs / ≥14 / >14
Altered mentation
Glasgow coma scale / Definition / 0 / 1
GCS main model / GCS_15 / 15 / <15
GCS 13 model / GCS_13 / 13-15 / <13
GCS 14 model / GCS_14 / 14-15 / <14
Arterial hypotension
Definition / 0 / 1
MAP / <2 years / ≥60 / <60
(main model) / 2 to 5 yrs / ≥62 / <62
>5 to 12 yrs / ≥65 / <65
>12 to <18 yrs / ≥67 / <67
SBP / <2 years / ≥75 / <75
(sbp model) / 2 to 5 yrs / ≥74 / <74
>5 to 12 yrs / ≥83 / <83
>12 to <18 yrs / ≥90 / <90
SBP_5 / <2 years / ≥ 67 (M), ≥ 68 (F) / < 67 (M), < 68 (F)
(sbp_5 model) / >2 to <3 years / ≥ 70 (M), ≥ 71 (F) / < 70 (M), < 71 (F)
>3 to <4 years / ≥ 73 (M), ≥ 71 (F) / < 73 (M), < 71 (F)
>4 to <5 years / ≥ 75 (M), ≥ 74 (F) / < 75 (M), < 74 (F)
>5 to <6 years / ≥ 78 (M), ≥ 76 (F) / < 78 (M), < 76 (F)
>6 to <7 years / ≥ 78 (M), ≥ 78 (F) / < 78 (M), < 78 (F)
>7 to <8 years / ≥ 79 (M), ≥ 78 (F) / < 79 (M), < 78 (F)
>8 to <9 years / ≥ 82 (M), ≥ 81 (F) / < 82 (M), < 81 (F)
>9 to <10 years / ≥ 82 (M), ≥ 83 (F) / < 82 (M), < 83 (F)
>10 to <11 years / ≥ 85 (M), ≥ 85 (F) / < 85 (M), < 85 (F)
>11 to <12 years / ≥ 87 (M), ≥ 85 (F) / < 87 (M), < 85 (F)
>12 to <13 years / ≥ 89 (M), ≥ 87 (F) / < 89 (M), < 87 (F)
>13 to <14 years / ≥ 90 (M), ≥ 90 (F) / < 90 (M), < 90 (F)
>14 to <15 years / ≥ 94 (M), ≥ 92 (F) / < 94 (M), < 92 (F)
>15 to <16 years / ≥ 95 (M), ≥ 93 (F) / < 95 (M), < 93 (F)
References:
Leteurtre S, Duhamel A, Salleron J, et al. PELOD-2: an update of the PEdiatric logistic organ dysfunction score. Crit Care Med. 2013;41(7):1761-1773.
Goldstein B, Giroir B, Randolph A. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6(1):2-8; and PediatrCrit Care Med. 2005 Jul;6(4):500; author reply 500-1.
Haque IU, Zaritsky AL. Analysis of the evidence for the lower limit of systolic and mean arterial pressure in children. Pediatr Crit Care Med. 2007;8(2):138-144.
Schlapbach LJ, MacLaren G, Festa M, et al. Prediction of pediatric sepsis mortality within 1 h of intensive care admission. Intensive Care Med. 2017;43(8):1085-1096.
Supplementary Table 2: Baseline, demographic and severity characteristics, of 2,574 children <18 years admitted to Intensive Care Units with infection. Patients are grouped by primary outcome (Survivors versus Nonsurvivors) and secondary outcome (survivors with ICU stay <3 days versus non survivors or survivors with ICU stay >2 days).
Factor / Level / Survivors / Non-survivors / p-value / Survivors with ICU stay <3 days / Non-survivors or survivors with ICU stay ≥3 days / p-valueN / N=2443 / N=151 / N=1645 / N=949
Demographics
age, median (IQR) / 13.0 (1.2, 16.7) / 13.5 (1.7, 17.0) / 0.22 / 10.0 (1.2, 16.5) / 15.1 (1.5, 17.0) / <0.001
Age category / < 2 years / 751 (30.7%) / 39 (25.8%) / 0.21 / 526 (32.0%) / 264 (27.8%) / <0.001
2 to <6 years / 258 (10.6%) / 11 (7.3%) / 206 (12.5%) / 63 (6.6%)
6 to <13 years / 199 (8.1%) / 16 (10.6%) / 147 (8.9%) / 68 (7.2%)
13 to <18 years / 1235 (50.6%) / 85 (56.3%) / 766 (46.6%) / 554 (58.4%)
Sex / Female / 1128 (46.2%) / 70 (46.4%) / 0.96 / 759 (46.1%) / 439 (46.3%) / 0.95
Male / 1315 (53.8%) / 81 (53.6%) / 886 (53.9%) / 510 (53.7%)
Type of Hospital / Rural/Regional / 696 (28.5%) / 38 (25.2%) / 0.66 / 484 (29.4%) / 250 (26.3%) / 0.033
Metropolitan / 386 (15.8%) / 24 (15.9%) / 235 (14.3%) / 175 (18.4%)
Tertiary/Teaching / 1258 (51.5%) / 80 (53.0%) / 854 (51.9%) / 484 (51.0%)
Private / 103 (4.2%) / 9 (6.0%) / 72 (4.4%) / 40 (4.2%)
Transferred to specialized PICU / No / 2307 (94.4%) / 138 (5.6%) / 0.119 / 1600 (65.4%) / 845 (34.6%) / <0.001
Yes / 136 (91.3%) / 13 (8.7%) / 45 (30.2%) / 104 (69.8%)
Severity
Invasive Ventilation / No / 1820 (74.6%) / 56 (37.6%) / <0.001 / 1425 (86.8%) / 451 (47.7%) / <0.001
Yes / 619 (25.4%) / 93 (62.4%) / 217 (13.2%) / 495 (52.3%)
Invasive or non-invasive ventilation / No / 1784 (73.1%) / 53 (35.6%) / <0.001 / 1401 (85.3%) / 436 (46.0%) / <0.001
Yes / 657 (26.9%) / 96 (64.4%) / 242 (14.7%) / 511 (54.0%)
ICU length of stay (hours) / median (IQR) / 41.0 (19.3, 88.3) / 34.9 (10.9, 105.3) / 0.25 / 26.9 (16.1, 44.4) / 113.8 (78.8, 190.8) / <0.001
Comorbidities
Comorbid conditions / No / 2189 (89.6%) / 105 (69.5%) / <0.001 / 1502 (91.3%) / 792 (83.5%) / <0.001
yes / 254 (10.4%) / 46 (30.5%) / 143 (8.7%) / 157 (16.5%)
Chronic respiratory disease / No / 2347 (96.1%) / 134 (88.7%) / <0.001 / 1598 (97.1%) / 883 (93.0%) / <0.001
Yes / 96 (3.9%) / 17 (11.3%) / 47 (2.9%) / 66 (7.0%)
Chronic cardiovascular disease / No / 2396 (98.1%) / 145 (96.0%) / 0.084 / 1618 (98.4%) / 923 (97.3%) / 0.057
Yes / 47 (1.9%) / 6 (4.0%) / 27 (1.6%) / 26 (2.7%)
Immunosuppression / No / 2329 (95.3%) / 121 (80.1%) / <0.001 / 1569 (95.4%) / 881 (92.8%) / 0.006
Yes / 114 (4.7%) / 30 (19.9%) / 76 (4.6%) / 68 (7.2%)
Other comorbidities / No / 2417 (98.9%) / 147 (97.4%) / 0.077 / 1634 (99.3%) / 930 (98.0%) / 0.002
Yes / 26 (1.1%) / 4 (2.6%) / 11 (0.7%) / 19 (2.0%)
Diagnosis
Sepsis / No / 1739 (71.2%) / 74 (49.0%) / <0.001 / 1179 (71.7%) / 634 (66.8%) / 0.009
Yes / 704 (28.8%) / 77 (51.0%) / 466 (28.3%) / 315 (33.2%)
Infection on admission / No / 207 (8.5%) / 3 (2.0%) / 0.005 / 160 (9.7%) / 50 (5.3%) / <0.001
Yes / 2236 (91.5%) / 148 (98.0%) / 1485 (90.3%) / 899 (94.7%)
Postoperative Infection / No / 2236 (91.5%) / 148 (98.0%) / 0.005 / 1485 (90.3%) / 899 (94.7%) / <0.001
Yes / 207 (8.5%) / 3 (2.0%) / 160 (9.7%) / 50 (5.3%)
Supplementary Table 3: Crude and Adjusted AUROCs for Discrimination Characteristics of SIRS, SOFA, PELOD-2 and qSOFA on ICU Admission Among Children With Infection (N = 2574)
Primary outcome: Hospital mortality / Secondary outcome: Mortality and/or LOS ≥3dArea under the Curve / Area under the Curve
Predictor / Definition / Crude / Adjusted
(fixed effects) / Adjusted
(fixed and random effects) / Crude / Adjusted
(fixed effects) / Adjusted
(fixed and random effects)
SIRS / SIRS N criteria / 0.630 / 0.727 / 0.727 / 0.603 / 0.676 / 0.677
SIRS≧2 criteria / 0.547 / 0.708 / 0.707 / 0.537 / 0.664 / 0.664
SIRS* / 0.559 / 0.710 / 0.708 / 0.551 / 0.664 / 0.664
Severe Sepsis / Severe sepsis criteria / 0.560 / 0.711 / 0.713 / 0.592 / 0.677 / 0.679
SOFA / SOFA score / 0.782 / 0.829 / 0.829 / 0.731 / 0.751 / 0.758
SOFA≧2 criteria / 0.595 / 0.743 / 0.727 / 0.615 / 0.701 / 0.705
PELOD-2 / PELOD score / 0.774 / 0.816 / 0.818 / 0.750 / 0.771 / 0.773
PELOD≧2 criteria / 0.601 / 0.726 / 0.728 / 0.613 / 0.694 / 0.698
PELOD≧8 criteria / 0.719 / 0.812 / 0.812 / 0.633 / 0.744 / 0.743
qSOFA / qSOFA score / 0.638 / 0.739 / 0.741 / 0.597 / 0.682 / 0.681
qSOFA≧2 criteria / 0.591 / 0.722 / 0.721 / 0.581 / 0.679 / 0.677
alternative qSOFA models / qSOFA_GCS13_sofa_map score / 0.624 / 0.735 / 0.737 / 0.594 / 0.681 / 0.680
qSOFA_GCS13_sofa_sbp score / 0.641 / 0.755 / 0.755 / 0.593 / 0.686 / 0.686
qSOFA_GCS13_sbp_5 score / 0.621 / 0.742 / 0.743 / 0.592 / 0.681 / 0.679
qSOFA_GCS14_sofa_map score / 0.626 / 0.735 / 0.736 / 0.595 / 0.682 / 0.681
qSOFA_GCS14_sofa_sbp score / 0.644 / 0.754 / 0.754 / 0.594 / 0.685 / 0.685
qSOFA_GCS14_sbp_5 score / 0.625 / 0.742 / 0.742 / 0.594 / 0.681 / 0.679
qSOFA_GCS15_sofa_map score / 0.638 / 0.739 / 0.741 / 0.597 / 0.682 / 0.681
qSOFA_GCS15_sofa_sbp score / 0.655 / 0.757 / 0.757 / 0.597 / 0.685 / 0.686
qSOFA_GCS15_sbp_5 score / 0.637 / 0.745 / 0.745 / 0.597 / 0.682 / 0.680
LOS, Intensive Care Unit length of stay; PELOD, Pediatric Logistic Organ Dysfunction;SIRS, Systemic Inflammatory Response Syndrome; SOFA, Sequential (Sepsis-related) Organ Failure Assessment; qSOFA, quick Sequential (Sepsis-related) Organ Failure Assessment
*≥2 SIRS criteria one of which must be abnormal temperature or white cell count.
A qSOFA of ≥2 discriminated infected patientswith sepsis (SOFA ≥2)from patientswith no organ dysfunction (SOFA <2) with a sensitivity of 60.7%, specificity of 69.1%, and positive and negative predictive values of 85.2%, and 37.6%, respectively (crude AUROC 0.65, adjusted AUROC 0.79).
Supplementary Figure 1:Unadjustedmortality (A) and mortality and/or ICU length of stay ≥3 days (B) and adjusted odds of mortality (C) among Patients <18 years with suspected infection admitted to ICU, according to number of SIRS criteria met.
C)Adjusted odds of mortality among Patients <18 years with suspected infection admitted to ICU, according to number of SIRS criteria met.
Supplementary Figure 2: Mortality and/or ICU length of stay of greater than ≥ days, by SIRS Criteria, PELOD-2 score, SOFA and qSOFA Score measured during the first 24 hours of ICU admission in patients <18 years admitted with suspected infection.
Supplementary Figure 3:Presence of organ dysfunction as defined by a SOFA score of ≥2 according to number of SIRS criteria met in the individual patients.
Absolute counts (A) and proportion (A) of patients with SOFA score of <2 versus ≥2 are shown.
Overall, 406/593 (68.5%) of infected patients without SIRS had organ dysfunction as defined by a SOFA score of 2 or higher, in comparison to 1,281/1,673 (76.6%) of infected patients with SIRS (p<0.001, Supplementary Figure 3).
References:
1.Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA : the journal of the American Medical Association. 2014;311(13):1308-1316.
2.Goldstein B, Giroir B, Randolph A. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6(1):2-8.
3.Gebara BM. Values for systolic blood pressure. Pediatr Crit Care Med. 2005;6(4):500; author reply 500-501.
4.Leteurtre S, Duhamel A, Salleron J, et al. PELOD-2: an update of the PEdiatric logistic organ dysfunction score. Crit Care Med. 2013;41(7):1761-1773.
5.Haque IU, Zaritsky AL. Analysis of the evidence for the lower limit of systolic and mean arterial pressure in children. Pediatr Crit Care Med. 2007;8(2):138-144.
6.Schlapbach LJ, MacLaren G, Festa M, et al. Prediction of pediatric sepsis mortality within 1 h of intensive care admission. Intensive Care Med. 2017;43(8):1085-1096.
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