TOPLINE

In children who had liver transplants and developed infections, the Phoenix Sepsis Score (PSS) identified all children who died in the pediatric ICU and outperformed the standard scores.

METHODOLOGY

• Researchers conducted a retrospective cohort study to evaluate the PSS for identifying high mortality risk in pediatric liver transplant recipients (younger than 18 years).
• They included 132 patients (median age, 10 months; 50.8% girls) admitted to the pediatric ICU at a Chinese hospital with suspected or confirmed infection within 24 hours of ICU admission between January 2020 and December 2023.
• The PSS was applied and compared with the International Pediatric Sepsis Consensus Conference (IPSCC) criteria. The prognostic performance was compared alongside the pediatric Sequential Organ Failure Assessment (pSOFA) and the Pediatric Risk of Mortality III (PRISM III).
• The primary outcome was pediatric ICU mortality. Secondary outcomes included length of stay in pediatric ICU, duration of mechanical ventilation, 28-day ventilator-free days, and 28-day pediatric ICU-free days.
• Score performance was evaluated using area under the receiver operating characteristic curve (AUROC), positive predictive value (PPV), and other measures.

TAKEAWAY

• Overall, 88.6% of patients met sepsis criteria. The pediatric ICU mortality was 28.8%, with all deaths occurring in those with sepsis (P = .006).
• The PSS-based sepsis criteria identified all patients who died (sensitivity 100.0%) and had a PPV of 32.48%, outperforming the IPSCC criteria (sensitivity, 65.79%; PPV, 28.09%). It also showed superior performance at identifying septic shock.
• The PSS showed the best prognostic accuracy for PICU mortality with an AUROC of 0.868, outperforming pSOFA (AUROC 0.825) and PRISM III (AUROC 0.852).
• Patients with sepsis had longer stays in pediatric ICU, longer mechanical ventilation, and fewer 28-day pediatric ICU-free days than those without sepsis.

IN PRACTICE

"The Phoenix Sepsis criteria achieves superior mortality risk identification over IPSCC criteria and score outperforms conventional scoring systems in predicting PICU mortality, supporting its risk stratification in pediatric liver transplant recipients," the authors of the study wrote.

SOURCE

The study was led by Teng Teng and Xinhui Wang, Shanghai Jiao Tong University, Shanghai, China. It was published online on August 3 in the European Journal of Pediatrics.

LIMITATIONS

The study had potential incorporation bias that may have overestimated score performance. The study was a single-center retrospective analysis with a small sample size. Deaths after liver transplant may have stemmed from non-infectious causes.

DISCLOSURES

The study was supported by grants from Shanghai PuJiang Programme and the Development Project for Innovative Teams of Clinical Subspecialties, Shanghai Children's Medical Center. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.