Comparison of Sepsis-2 and Sepsis-3 definition in pediatric population
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Abstract
BACKGROUND: Sepsis is a severe disease that is associated with significant morbidity and mortality in both adult and pediatric patients. In 2016, the definition of sepsis was reevaluated in adult population and characterized as a state of organ dysfunction in response to an infection. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) standardized the use of the Sequential Organ Failure Assessment (SOFA) for diagnosing adult septic cases. Unfortunately, the consensus conference did not address pediatric sepsis. The SOFA specific to pediatric population was not available then. Following the Sepsis-3 definition, several SOFA tools were proposed for pediatric use (pSOFA). One of the pSOFA was validated in a cohort.
OBJECTIVE: The focus of this study was to validate the new definition of sepsis in pediatric patients by using a newly developed pSOFA tool. In addition, the study attempted to identify risk factors associated with mortality and sepsis in children.
METHODS: This study examined a total of 806 critically ill pediatric patients who were admitted to the pediatric ICUs with the diagnosis of sepsis at Boston Children’s Hospital from 2014 to 2019. Patient information was collected on demographics, length of stay in the ICU, outcomes, types of microbes detected, types of antibiotics used, and blood laboratory tests. This information was used to derive an organ failure score using the pSOFA tool. The pSOFA score was obtained by totaling subscores for the respiratory, coagulation, hepatic, cardiovascular and renal systems.
RESULTS: Each of the five pSOFA subscores, when elevated above average, was associated with meeting Sepsis-3 criteria in pediatric patients. An pSOFA score above average was also associated with a greater chance of mortality in children. An increased respiratory subscore above average was shown to be more significantly associated with mortality with an odds ratio of 1.71 in children. An above average hepatic and coagulation subscore were also showed to be positively associated with mortality with odds ratios of 1.38 and 1.34, respectively. An increased renal and cardiovascular subscores above average were not found to be a significant predictor of mortality.
CONCLUSIONS: The use of the Sepsis-3 criteria was better at predicting the outcome of pediatric patients diagnosed with sepsis than widely used Sepsis-2 definition in pediatric sepsis. Of the organ systems that were evaluated, respiratory dysfunction appears to be associated the most associated with increased mortality in pediatric patients.
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Attribution 4.0 International