Faculty Collaboration Database

Testing the prognostic accuracy of the updated pediatric sepsis biomarker risk model. PLoS One 2014;9(1):e86242

Date

02/04/2014

Pubmed ID

24489704

Pubmed Central ID

PMC3906040

DOI

10.1371/journal.pone.0086242

Scopus ID

2-s2.0-84897378910 (requires institutional sign-in at Scopus site)   67 Citations

Abstract

BACKGROUND: We previously derived and validated a risk model to estimate mortality probability in children with septic shock (PERSEVERE; PEdiatRic SEpsis biomarkEr Risk modEl). PERSEVERE uses five biomarkers and age to estimate mortality probability. After the initial derivation and validation of PERSEVERE, we combined the derivation and validation cohorts (n = 355) and updated PERSEVERE. An important step in the development of updated risk models is to test their accuracy using an independent test cohort.

OBJECTIVE: To test the prognostic accuracy of the updated version PERSEVERE in an independent test cohort.

METHODS: Study subjects were recruited from multiple pediatric intensive care units in the United States. Biomarkers were measured in 182 pediatric subjects with septic shock using serum samples obtained during the first 24 hours of presentation. The accuracy of PERSEVERE 28-day mortality risk estimate was tested using diagnostic test statistics, and the net reclassification improvement (NRI) was used to test whether PERSEVERE adds information to a physiology-based scoring system.

RESULTS: Mortality in the test cohort was 13.2%. Using a risk cut-off of 2.5%, the sensitivity of PERSEVERE for mortality was 83% (95% CI 62-95), specificity was 75% (68-82), positive predictive value was 34% (22-47), and negative predictive value was 97% (91-99). The area under the receiver operating characteristic curve was 0.81 (0.70-0.92). The false positive subjects had a greater degree of organ failure burden and longer intensive care unit length of stay, compared to the true negative subjects. When adding PERSEVERE to a physiology-based scoring system, the net reclassification improvement was 0.91 (0.47-1.35; p<0.001).

CONCLUSIONS: The updated version of PERSEVERE estimates mortality probability reliably in a heterogeneous test cohort of children with septic shock and provides information over and above a physiology-based scoring system.

Author List

Wong HR, Weiss SL, Giuliano JS Jr, Wainwright MS, Cvijanovich NZ, Thomas NJ, Allen GL, Anas N, Bigham MT, Hall M, Freishtat RJ, Sen A, Meyer K, Checchia PA, Shanley TP, Nowak J, Quasney M, Chopra A, Fitzgerald JC, Gedeit R, Banschbach S, Beckman E, Lahni P, Hart K, Lindsell CJ

Author

Rainer G. Gedeit MD Associate Chief Medical Officer in the Children's Administration department at Children's Wisconsin

MESH terms used to index this publication - Major topics in bold

Biomarkers
Chemokine CCL3
Child
Child, Preschool
Female
Granzymes
HSP70 Heat-Shock Proteins
Humans
Intensive Care Units
Interleukin-8
Male
Matrix Metalloproteinase 8
Models, Statistical
Predictive Value of Tests
Prognosis
Risk Assessment
Shock, Septic
Survival Analysis