Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock.

Autor:	Sanchez-Pinto LN; Departments of Pediatrics (Critical Care) and Preventive Medicine (Health and Biomedical Informatics), Northwestern University Feinberg School of Medicine, and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois., Bennett TD; Departments of Biomedical Informatics and Pediatrics (Critical Care Medicine), University of Colorado School of Medicine, and Children's Hospital Colorado, Aurora., DeWitt PE; Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora., Russell S; Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora., Rebull MN; Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora., Martin B; Departments of Biomedical Informatics and Pediatrics (Critical Care Medicine), University of Colorado School of Medicine, and Children's Hospital Colorado, Aurora., Akech S; Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Nairobi, Kenya., Albers DJ; Departments of Biomedical Informatics, Bioengineering, Biostatistics, and Informatics, University of Colorado School of Medicine, Aurora.; Department of Biomedical Informatics, Columbia University, New York, New York., Alpern ER; Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, Illinois., Balamuth F; Department of Pediatrics, University of Pennsylvania, Perelman School of Medicine and Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia., Bembea M; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland., Chisti MJ; Intensive Care Unit, Dhaka Hospital, Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh., Evans I; Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Horvat CM; Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Jaramillo-Bustamante JC; Pediatric Intensive Care Unit, Hospital General de Medellín Luz Castro de Gutiérrez and Hospital Pablo Tobón Uribe, and Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Medellín, Colombia., Kissoon N; Department of Pediatrics, University of British Columbia, Vancouver, Canada., Menon K; Department of Pediatrics, Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada., Scott HF; Department of Pediatrics (Pediatric Emergency Medicine), University of Colorado School of Medicine, and Children's Hospital Colorado, Aurora., Weiss SL; Division of Critical Care, Department of Pediatrics, Nemours Children's Health, Wilmington, Delaware.; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania., Wiens MO; Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada.; Institute for Global Health, BC Children's Hospital, Vancouver, British Columbia, Canada.; Walimu, Kampala, Uganda., Zimmerman JJ; Seattle Children's Hospital and Department of Pediatrics, University of Washington School of Medicine, Seattle., Argent AC; Paediatrics and Child Health, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa., Sorce LR; Department of Pediatrics, Northwestern University Feinberg School of Medicine, and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois., Schlapbach LJ; Department of Intensive Care and Neonatology, Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.; Child Health Research Centre, The University of Queensland, Brisbane, Australia., Watson RS; Department of Pediatrics, University of Washington, and Center for Child Health, Behavior, and Development and Pediatric Critical Care, Seattle Children's Hospital, Seattle., Biban P; Verona University Hospital, Verona, Italy., Carrol E; University of Liverpool, Liverpool, England., Chiotos K; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Flauzino De Oliveira C; Associação de Medicina Intensiva Brasileira, São Paulo, Brazil., Hall MW; Nationwide Children's Hospital, Columbus, Ohio., Inwald D; Addenbrooke's Hospital, Cambridge University Hospital NHS Trust, Cambridge, England., Ishimine P; University of California, San Diego School of Medicine, La Jolla., Levin M; Imperial College London, London, England., Lodha R; All India Institute of Medical Sciences, New Delhi, India., Nadel S; St Mary's Hospital, London, England., Nakagawa S; National Center for Child Health and Development, Tokyo, Japan., Peters MJ; University College London Great Ormond Street Institute of Child Health, London, England., Randolph AG; Boston Children's Hospital, Boston, Massachusetts., Ranjit S; Apollo Children's Hospital, Chennai, India., Souza DC; University Hospital of the University of São Paulo, Sao Paulo, Brazil., Tissieres P; Hôpital de Bicêtre, Paris, France., Wynn JL; University of Florida, Gainesville.
Jazyk:	angličtina
Zdroj:	JAMA [JAMA] 2024 Feb 27; Vol. 331 (8), pp. 675-686.
DOI:	10.1001/jama.2024.0196
Abstrakt:	Importance: The Society of Critical Care Medicine Pediatric Sepsis Definition Task Force sought to develop and validate new clinical criteria for pediatric sepsis and septic shock using measures of organ dysfunction through a data-driven approach. Objective: To derive and validate novel criteria for pediatric sepsis and septic shock across differently resourced settings. Design, Setting, and Participants: Multicenter, international, retrospective cohort study in 10 health systems in the US, Colombia, Bangladesh, China, and Kenya, 3 of which were used as external validation sites. Data were collected from emergency and inpatient encounters for children (aged <18 years) from 2010 to 2019: 3 049 699 in the development (including derivation and internal validation) set and 581 317 in the external validation set. Exposure: Stacked regression models to predict mortality in children with suspected infection were derived and validated using the best-performing organ dysfunction subscores from 8 existing scores. The final model was then translated into an integer-based score used to establish binary criteria for sepsis and septic shock. Main Outcomes and Measures: The primary outcome for all analyses was in-hospital mortality. Model- and integer-based score performance measures included the area under the precision recall curve (AUPRC; primary) and area under the receiver operating characteristic curve (AUROC; secondary). For binary criteria, primary performance measures were positive predictive value and sensitivity. Results: Among the 172 984 children with suspected infection in the first 24 hours (development set; 1.2% mortality), a 4-organ-system model performed best. The integer version of that model, the Phoenix Sepsis Score, had AUPRCs of 0.23 to 0.38 (95% CI range, 0.20-0.39) and AUROCs of 0.71 to 0.92 (95% CI range, 0.70-0.92) to predict mortality in the validation sets. Using a Phoenix Sepsis Score of 2 points or higher in children with suspected infection as criteria for sepsis and sepsis plus 1 or more cardiovascular point as criteria for septic shock resulted in a higher positive predictive value and higher or similar sensitivity compared with the 2005 International Pediatric Sepsis Consensus Conference (IPSCC) criteria across differently resourced settings. Conclusions and Relevance: The novel Phoenix sepsis criteria, which were derived and validated using data from higher- and lower-resource settings, had improved performance for the diagnosis of pediatric sepsis and septic shock compared with the existing IPSCC criteria.
Databáze:	MEDLINE
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