ABSTRACT
Objective To determine the threshold of the inotropic score (IS) and vasoactive–inotropic score (VIS) for predicting mortality in pediatric septic shock. Method This retrospective cohort study included children aged 1 mo to 13 y with septic shock, requiring vasoactive medication. The area under curve receiver operating characteristic (AUROC) was calculated using mean IS and mean VIS to predict PICU mortality, and Youden index cut points were generated. Sensitivity, specifcity, and binary regression analysis were performed. Results A total of 176 patients were enrolled (survivor, n=72, 41% and nonsurvivor, n=104, 59%). For predicting the PICU mortality, AUROC (95% CI) of IS was 0.80 (0.74–0.86) [sensitivity of 88.5 (80.7–94) and specifcity of 58.3 (46.1–69.8)] and AUROC of VIS was 0.88 (0.82–0.92) [sensitivity of 83.7 (75.1–90.2) and specifcity of 80.6 (69.5–89)]. The respective cutof scores of IS and VIS were 28 and 42.5. On regression analysis (adjusted odds ratio, 95% CI), illness severity (PRISM-III) (1.12, 1.05–1.12), worst lactate value (1.31, 1.08–1.58), IS (>28) (3.98, 1.24–12.80), and VIS (>42.5) (4.66, 1.57–13.87) independently predicted the PICU mortality (r 2=0.625). Conclusion Threshold of inotropic score (>28) and vasoactive–inotropic score (>42.5) were independently associated with PICU mortality. In addition to IS and VIS, severity and worst lactate value independently predicted septic shock mortality in PICU.
ABSTRACT
Objective: To study the effect of the second dose of scorpion antivenom in children with nonresolving or worsening scorpion sting envenomation. Methods: 72 children aged ?12 yearswith scorpion sting envenomation grade 2 and above were enrolled. 61 received the first doseof three vials of antivenom at admission (group A). Children with persistent/worseningenvenomation within 6 hours received the second dose (group B). The time required forresolution of autonomic symptoms, myocardial dysfunction, predictors of the second doseand side effects were studied. Results: The mean time taken for resolution of autonomicsymptoms were comparable in Group A and B (4.1 vs. 5.3 h, P=0.4), and of myocardialdysfunction was shorter in Group A (10.8 vs. 37.6 h, P=0.02). On regression analysis,abnormal echocardiography at admission was found to be a significant predictor of thesecond dose (OR=27.6, 95% CI, 4.7–162.5; P=<0.001). Conclusion: Children with severescorpion sting envenomation with abnormal echocardiography may require a higher dose ofscorpion antivenom. Trial registration: CTRI/2015/03/005652.