Dynamic Prediction of Mortality Using Longitudinally Measured Pediatric Sequential Organ Failure Assessment Scores: A Joint Modeling Approach.
Pediatr Crit Care Med
; 25(5): 443-451, 2024 May 01.
Article
em En
| MEDLINE
| ID: mdl-38695693
ABSTRACT
OBJECTIVES:
The pediatric Sequential Organ Failure Assessment (pSOFA) score was designed to track illness severity and predict mortality in critically ill children. Most commonly, pSOFA at a point in time is used to assess a static patient condition. However, this approach has a significant drawback because it fails to consider any changes in a patients' condition during their PICU stay and, especially, their response to initial critical care treatment. We aimed to evaluate the performance of longitudinal pSOFA scores for predicting mortality.DESIGN:
Single-center, retrospective cohort study.SETTING:
Quaternary 40-bed PICU. PATIENTS All patients admitted to the PICU between 2015 and 2021 with at least 24 hours of ICU stay.INTERVENTIONS:
None. MEASUREMENTS AND MAINRESULTS:
We calculated daily pSOFA scores up to 30 days, or until death or discharge from the PICU, if earlier. We used the joint longitudinal and time-to-event data model for the dynamic prediction of 30-day in-hospital mortality. The dataset, which included 9146 patients with a 30-day in-hospital mortality of 2.6%, was divided randomly into training (75%) and validation (25%) subsets, and subjected to 40 repeated stratified cross-validations. We used dynamic area under the curve (AUC) to evaluate the discriminative performance of the model. Compared with the admission-day pSOFA score, AUC for predicting mortality between days 5 and 30 was improved on average by 6.4% (95% CI, 6.3-6.6%) using longitudinal pSOFA scores from the first 3 days and 9.2% (95% CI, 9.0-9.5%) using scores from the first 5 days.CONCLUSIONS:
Compared with admission-day pSOFA score, longitudinal pSOFA scores improved the accuracy of mortality prediction in PICU patients at a single center. The pSOFA score has the potential to be used dynamically for the evaluation of patient conditions.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Unidades de Terapia Intensiva Pediátrica
/
Mortalidade Hospitalar
/
Estado Terminal
/
Escores de Disfunção Orgânica
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Marrocos