Paediatric sequential organ failure assessment (pSOFA) score: A new mortality prediction score in the paediatric intensive care unit
Abstract
Objectives: To evaluate the effectiveness of the age-adapted SOFA score in children admitted to Paediatric Intensive Care Units (PICUs) and determine whether it outperforms the systemic inflammatory response syndrome (SIRS) criteria in diagnosing sepsis, in line with Sepsis-3 consensus guidelines.
Methods: This prospective observational study was conducted across two centers and included 281 children admitted to the PICU. SOFA, Pediatric Risk of Mortality (PRISM), and Pediatric Index of Mortality-2 (PIM2) scores were calculated at admission, alongside assessment for SIRS. The primary outcome measured was 30-day mortality.
Results: SOFA scores were significantly higher among nonsurvivors (P<.001), with mortality rates increasing in line with higher SOFA scores. Receiver operating characteristic (ROC) analysis showed the SOFA score had an area under the curve (AUC) of 0.89 for predicting 30-day mortality, outperforming PRISM (AUC 0.84) and PIM2 (AUC 0.79). For predicting prolonged PICU stay, the SOFA AUC was 0.67. SOFA scores correlated moderately with PRISM (rs=0.59) and PIM2 (rs=0.51). Among children with infections, the SOFA score had an AUC of 0.87 for predicting mortality, compared to 0.60 for SIRS. A SOFA threshold of ≥3 points provided better mortality prediction than both SIRS and the Sepsis-3 recommended cutoff of ≥2. Conclusions: The age-adapted SOFA score is a valuable tool for predicting LGH447 outcomes in the PICU and demonstrates superior accuracy over SIRS in identifying pediatric sepsis.