Pediatric Sepsis Biomarker Risk Model-II: Redefining the Pediatric Sepsis Biomarker Risk Model With Septic Shock Phenotype.
Pediatric Sepsis Biomarker Risk Model-II: Redefining the Pediatric Sepsis Biomarker Risk Model With Septic Shock Phenotype.
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DOI：
10.1097/ccm.0000000000001852
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发表时间：
2016-11
影响因子：
8.8
通讯作者：
Lindsell CJ
中科院分区：
文献类型：
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作者：
Wong HR;Cvijanovich NZ;Anas N;Allen GL;Thomas NJ;Bigham MT;Weiss SL;Fitzgerald J;Checchia PA;Meyer K;Quasney M;Hall M;Gedeit R;Freishtat RJ;Nowak J;Raj SS;Gertz S;Howard K;Harmon K;Lahni P;Frank E;Hart KW;Nguyen TC;Lindsell CJ
PERSEVERE是一种儿科脓毒症风险模型，使用生物标志物来估计儿科脓毒症休克的基线死亡风险。目前尚不清楚PERSEVERE在不同感染性休克表型中的表现。我们在感染性休克和血小板减少相关的多器官衰竭（TAMOF）儿童以及没有新发血小板减少但有多器官衰竭（MOF）的儿童中测试了PERSEVERE。为每例研究受试者（n = 660）生成基于PERSEVER的死亡风险。先验地，我们确定如果PERSEVERE在TAMOF和MOF队列中表现不佳，我们将修订PERSEVERE以纳入入院血小板计数。美国多个儿科重症监护病房。标准护理。PERSEVERE在TAMOF队列中表现良好（AUC 0.84 [95% CI：0.77 - 0.90]），但在MOF队列中表现较差（AUC 0.71; [0.61 - 0.80]）。使用424例既往在推导阶段报告的受试者对PERSEVERE进行了翻修。PERSEVERE-II的AUC为0.89（0.85 - 0.93），在TAMOF和MOF队列中表现同样良好。在236例新入组的受试者中进行测试时，PERSEVERE-II表现良好。一项临床试验的样本量计算测试了血浆置换对感染性休克和TAMOF儿童的疗效，结果表明，与无分层相比，基于PERSEVERE-II的分层可大幅减少必要的患者数量。在感染性休克表型的背景下测试PERSEVERE促使修订纳入血小板计数。PERSEVERE-II在测试时表现良好，与TAMOF或MOF状态无关。PERSEVERE-II有可能作为一种预后富集工具。
PERSEVERE, a pediatric sepsis risk model, uses biomarkers to estimate baseline mortality risk for pediatric septic shock. It is unknown how PERSEVERE performs within distinct septic shock phenotypes. We tested PERSEVERE in children with septic shock and thrombocytopenia-associated multiple organ failure (TAMOF), and in those without new onset thrombocytopenia but with multiple organ failure (MOF). PERSEVERE-based mortality risk was generated for each study subject (n = 660). A priori, we determined that if PERSEVERE did not perform well in both the TAMOF and MOF cohorts, we would revise PERSEVERE to incorporate admission platelet counts. Multiple pediatric intensive care units in the United States. Standard care. PERSEVERE performed well in the TAMOF cohort (AUC 0.84 [95% CI: 0.77 – 0.90]), but less well in the MOF cohort (AUC 0.71; [0.61 – 0.80]). PERSEVERE was revised using 424 subjects previously reported in the derivation phase. PERSEVERE-II had an AUC of 0.89 (0.85 – 0.93) and performed equally well across TAMOF and MOF cohorts. PERSEVERE-II performed well when tested in 236 newly enrolled subjects. Sample size calculations for a clinical trial testing the efficacy of plasma exchange for children with septic shock and TAMOF indicated PERSEVERE-II-based stratification could substantially reduce the number of patients necessary, when compared to no stratification. Testing PERSEVERE in the context of septic shock phenotypes prompted a revision incorporating platelet count. PERSEVERE-II performs well upon testing, independent of TAMOF or MOF status. PERSEVERE-II could potentially serve as a prognostic enrichment tool.