By Lynda Williams, medwireNews Reporter
medwireNews: The Phoenix Sepsis Score “accurately” characterises the risk of definitely attributable mortality from sepsis and the duration of intensive care unit (ICU) stay in children undergoing cancer treatment who have a suspected infection, US researchers report in a research letter to JAMA Network Open.
The Phoenix Sepsis Score “numerically outperformed existing scores for attributable mortality,” say Joshua Wolf (St Jude Children’s Research Hospital, Memphis, Tennessee) and co-workers.
Although the recently described Phoenix Sepsis Score is “recommended for all pediatric populations”, the researchers explain that the model, which assigns points based on potentially life-threatening organ dysfunction relating to the cardiovascular, respiratory, neurological and coagulation systems, has not been validated in paediatric oncology and may be affected by pre-existing organ dysfunction in children with cancer.
To investigate further, the team collated information for 60 girls and 83 boys, aged a median of 10.3 years, who were admitted to the St Jude Children’s Research Hospital ICU with suspected infection between 2013 and 2019. The children were all undergoing cancer treatment for haematological (56.6%) or solid malignancies, although patients were excluded if their most recent treatment was haematopoietic stem cell transplantation.
There were 171 identified episodes of suspected sepsis in the 143 participants, 9.9% of whom died. Deaths attributable or definitely attributable to sepsis occurred in 9.9% and 7.6% of patients, respectively. In addition, 21.6% of patients had a prolonged ICU stay, defined as more than 7 days.
There was a significant relationship between the 24-hour Phoenix Sepsis Score and the likelihood of attributable mortality, definitely attributable mortality, all-cause mortality and prolonged ICU stay, Wolf and co-authors report.
Moreover, the area under the receiver operating characteristic curve for the 24-hour Phoenix Sepsis Score was numerically better at predicting attributable and definitely attributable mortality than the Phoenix Score excluding the platelet count, as well as standard scoring systems for sepsis, namely the Pediatric Risk of Mortality 3, Pediatric Sequential Organ Failure Assessment (pSOFA), the quick SOFA and the Paediatric Logistic Organ Dysfunction 2.
Using a cutoff of 2 points or higher, the Phoenix Sepsis Score accurately classified 75% of the episodes as sepsis. The score was 77% sensitive and 25% specific for identification of attributable mortality and a corresponding 89% and 25% for definitely attributable mortality.
Using a cutoff of 4 points or higher, the sensitivity and specificity for attributable mortality were 69% and 72%, respectively, and 89% and 72% for definitely attributable mortality, report Wolf et al.
“Relatively poor performance of sepsis scores for attributable mortality in this population may be caused by delayed death and/or preexisting subclinical multiorgan dysfunction from cancer or chemotherapy”, the researchers observe.
“However, the temptation to focus only on definitely attributable mortality should be resisted as it might underestimate true sepsis-related mortality”, they advise.
The team acknowledges that the study is limited by a small, retrospective patient sample and the exclusion of patients who recently underwent stem cell transplantation. The authors therefore conclude: “More research is needed to validate these findings, evaluate population-specific cutoffs, and identify approaches that predict delayed attributable mortality.”
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JAMA Networ Open 2024; doi:10.1001/jamanetworkopen.2024.15917