The Role of Blood Purification by HA330 as Adjunctive Treatment in Children with Septic Shock.

INTRODUCTION: Despite advances in supportive care for critically ill patients, sepsis remains an important cause of death worldwide in the PICU. One of the hallmarks of sepsis is hyperinflammation due to the excessive release of inflammatory mediators. Recently, new therapeutic approaches, such as immune modulation and blood purification, have been tried to improve outcomes in patients with septic shock. METHODS: This study is a prospective observational study composed of children with septic shock and the PELOD-2 score ≥10 or the PRISM-3 score ≥15. All received 2-4 h of HA330 treatment on 2 consecutive days, used as adjunctive therapy. The effectiveness of HA330 hemoperfusion was evaluated by improving the PELOD-2 and PRISM-3 scores, the vasoactive inotropic score (VIS), and inflammatory markers from baseline to 72 h after the use of HA330 hemoperfusion. RESULTS: Twelve patients hospitalized in the PICU and diagnosed with septic shock between July 2021 and May 2022 were included in this study and received hemoperfusion with HA330. The average PELOD-2 and PRISM-3 scores decreased significantly from 9.5 (IQR: 6.5-13.0) at baseline to 2.0 (IQR: 0-6.5) at 72 h (p = 0.002) and from 16.5 (IQR: 15.0-20.5) at baseline to 5.5 (IQR: 2.0-9.5) at 72 h (p = 0.002), respectively. The VIS decreased significantly from baseline to 72 h (p = 0.003). IL-6, procalcitonin, and lactate levels also decreased significantly from baseline to 72 h (p = 0.005, 0.03, and 0.03, respectively). Two of 12 patients expired due to their underlying condition (2/12, 16.7%). Device-related adverse events did not occur in this study. CONCLUSIONS: Our observational case series suggests a possible role for HA330 hemoperfusion as an adjunctive treatment of refractory septic shock in children with high severity scores in the context of rapid improvement in organ dysfunction, without serious adverse effects.

Day-1 PELOD-2 and day-1 "quick" PELOD-2 scores in children with sepsis in the PICU.

OBJECTIVES: This study aimed to evaluate the predictive validity of the day-1 PELOD-2 and day-1 "quick" PELOD-2 (qPELOD-2) scores for in-hospital mortality in children with sepsis in a pediatric intensive care unit (PICU) of a developing country. METHODS: The data of 516 children diagnosed as sepsis were retrospectively analyzed. The children were divided into survival group and non-survival group, according to the clinical outcome 28 days after admission. Day-1 PELOD-2, day-1 qPELOD-2, pediatric SOFA (pSOFA), and P-MODS were collected and scored. Receiver operating characteristic (ROC) curves were plotted, and the efficiency of the day-1 PELOD-2, day-1 qPELOD-2 score, pSOFA, and P-MODS for predicting death were evaluated by the area under the ROC curve (AUC). RESULTS: The day-1 PELOD-2 score, day-1 qPELOD-2 score, pSOFA, and P-MODS in the non-survivor group were significantly higher than those in the survivor group. ROC curve analysis showed that the AUCs of the day-1 PELOD-2 score, day-1 qPELOD-2 score, pSOFA, and P-MODS for predicting the prognosis of children with sepsis in the PICU were 0.916, 0.802, 0.937, and 0.761, respectively (all p < 0.05). CONCLUSIONS: Both the day-1 PELOD-2 score and day-1 qPELOD-2 score were effective and able to assess the prognosis of children with sepsis in a PICU of a developing country. Additionally, the day-1 PELOD-2 score was superior to the day-1 qPELOD-2 score. Further studies are needed to verify the usefulness of the day-1 qPELOD-2 score, particularly outside of the PICU.

Pediatric Logistic Organ Dysfunction-2 (Pelod-2) score as a model for predicting mortality in pediatric burn injury.

Multiple organ dysfunction syndrome (MODS) is an important cause of mortality in burn injury. Pediatric Organ Logistic Dysfunction (PELOD)-2 score as a descriptive scoring system for organ dysfunction has been highly predictive of mortality in children with suspected infection, but its usefulness for burn patients is unknown. All pediatric burn patients hospitalized in Cipto Mangunkusumo Hospital (CMH) in Jakarta, Indonesia, from January 2012 to January 2017 were studied. Gender, age, nutritional status, burn characteristics, total body surface area burned (%TBSA), depth of burn, inhalation injury, time interval to resuscitation and surgery, day one ABSI and PELOD-2 score, and mortality as outcome were recorded. Bivariate and multivariate analysis logistic regressions were done to generate a mortality prediction model. Mortality rate among subjects was 20.3%. Bivariate analysis showed that extensive %TBSA, depth of burn, presence of inhalation injury, PELOD-2 score and ABSI score in pediatric burn patients were significantly associated with mortality (p<0.001). In multivariate analysis, only PELOD-2 score was independently associated with mortality. PELOD-2 score mortality prediction rate was far lower than actual mortality. Mortality rate by the new model was close to the actual mortality rate. Our new combined model could be used to calculate probability of death based on day 1 PELOD-2 score in pediatric burn patients.

La mort après brûlure est fréquemment due à une défaillance multiviscérale. Le score PELOD 2 s'est révélé efficace dans la prédiction de mortalité de l'enfant septique mais n'a pas été évalué chez l'enfant brûlé. Tous les enfants brûlés hospitalisés dans l'hôpital Cipto Mangunkusumo de Djakarta (Indonésie) entre janvier 2012 et janvier 2017 ont été évalués. L'âge, le sexe, l'état nutritionnel, la surface brûlée, sa profondeur, l'existence d'une inhalation de fumées, les délais jusqu'à la réanimation et la chirurgie, ABSI et PELOD 2 à J1 et mortalité (20,3%) ont été colligés. Des analyse bivariée puis multivariée ont été réalisées afin de construire un modèle prédictif de mortalité. PELOD 2 comme ABSI étaient de bons prédicteurs de mortalité, les prédictions de PELOD 2 s'avérant très optimistes. Toutefois, seul PELOD 2 apparaissait comme un prédicteur indépendant de mortalité. Un modèle combinant les mortalités prédites par ABSI et PELOD 2 s'est avéré mieux corrélé à la mortalité observée. Il pourrait être utilisé chez les enfants brûlés.

Day-1 PELOD-2 and day-1 quick PELOD-2 scores in children with sepsis in the PICU / Desempenhos dos escores PELOD-2 no dia 1 e quick PELOD-2 no dia 1 em crianças com sepse na UTIP

Abstract Objectives: This study aimed to evaluate the predictive validity of the day-1 PELOD-2 and day-1 "quick" PELOD-2 (qPELOD-2) scores for in-hospital mortality in children with sepsis in a pediatric intensive care unit (PICU) of a developing country. Methods: The data of 516 children diagnosed as sepsis were retrospectively analyzed. The children were divided into survival group and non-survival group, according to the clinical outcome 28 days after admission. Day-1 PELOD-2, day-1 qPELOD-2, pediatric SOFA (pSOFA), and P-MODS were collected and scored. Receiver operating characteristic (ROC) curves were plotted, and the efficiency of the day-1 PELOD-2, day-1 qPELOD-2 score, pSOFA, and P-MODS for predicting death were evaluated by the area under the ROC curve (AUC). Results: The day-1 PELOD-2 score, day-1 qPELOD-2 score, pSOFA, and P-MODS in the non-survivor group were significantly higher than those in the survivor group. ROC curve analysis showed that the AUCs of the day-1 PELOD-2 score, day-1 qPELOD-2 score, pSOFA, and P-MODS for predicting the prognosis of children with sepsis in the PICU were 0.916, 0.802, 0.937, and 0.761, respectively (all p < 0.05). Conclusions: Both the day-1 PELOD-2 score and day-1 qPELOD-2 score were effective and able to assess the prognosis of children with sepsis in a PICU of a developing country. Additionally, the day-1 PELOD-2 score was superior to the day-1 qPELOD-2 score. Further studies are needed to verify the usefulness of the day-1 qPELOD-2 score, particularly outside of the PICU.

Resumo Objetivos: A finalidade de nosso estudo foi avaliar a validade preditiva dos escores PELOD-2 no dia 1 e "quick" PELOD-2 no dia 1 com relação à mortalidade hospitalar em crianças com sepse em uma UTIP de um país em desenvolvimento. Métodos: Foram analisados retrospectivamente os dados de 516 crianças diagnosticadas com sepse. As crianças foram divididas em grupo sobrevida e grupo não sobrevida de acordo com o desfecho clínico de 28 dias após internação. Foram coletadas e pontuadas as variáveis PELOD-2 no dia 1, qPELOD-2 no dia 1, pediatric Sequential Organ Failure Assessment (pSOFA) e Pediatric Multiple Organ Dysfunction Score (P-MODS). A curva da característica de operação do receptor (ROC) foi plotada e a eficiência preditiva do PELOD-2 no dia 1, o escore qPELOD-2 no dia 1, pSOFA, P-MODS com relação a óbito foram avaliados pela área abaixo da curva (AUC) da curva ROC. Resultados: O escore PELOD-2 no dia 1, escore qPELOD-2 no dia 1, pSOFA e P-MODS no grupo não sobrevida foram significativamente maiores do que os no grupo sobrevida. A análise preditiva da curva ROC mostrou que as AUCs do escore PELOD-2 no dia 1, escore qPELOD-2 no dia 1, pSOFA e P-MODS com relação ao prognóstico de crianças com sepse na UTIP foi 0,916, 0,802, 0,937 e 0,761, respectivamente (todas p < 0,05). Conclusões: Tanto o escore PELOD-2 no dia 1 e o escore qPELOD-2 no dia 1 foram válidos e conseguiram avaliar o prognóstico de crianças com sepse em uma UTIP de um país em desenvolvimento. Além disso, o escore PELOD-2 no dia 1 foi superior ao escore qPELOD-2 no dia 1. São necessários estudos adicionais para verificar a utilidade do escore qPELOD-2 no dia 1, principalmente fora da UTIP.