Value of modified qSOFA, glucose and lactate in predicting prognosis in children with sepsis in the PICU

Abstract

The purpose was to investigate how well age-adjusted modified quick Sequential Organ Failure Assessment (qSOFA) scores paired with blood glucose and lactate levels predict the outcomes of septicemic children in the pediatric intensive care unit (PICU). One hundred children who were diagnosed with sepsis and septic shock in the PICU of Henan Children’s Hospital were eligible, and other 20 patients in the same hospital at different times were selected as a validation set. Respiratory rate (RR), heart rate (HR), capillary refill time (CRT), and Alert, Voice, Pain, Unresponsive (AVPU) scale were included in the age-adjusted modified qSOFA scoring criteria for scoring. The primary outcome was 28-day all-cause mortality. The predictive values were evaluated by the ROC curve. In the sepsis group, 50 patients were male, and 50 patients were female. The 28-day all-cause mortality rate was 52%. Fifty-one patients with age-adjusted modified qSOFA scores >1. The serum lactate level was 2.4 mmol/L, and the blood glucose level was 9.3 mmol/L. The AUCs for the age-adjusted modified qSOFA score, serum lactate and blood glucose levels for the prediction of 28-day all-cause mortality in children with sepsis were 0.719, 0.719 and 0.737, respectively. The cut-off values were one point, 3.8 mmol/L and 10 mmol/L, respectively. The AUC of the age-adjusted modified qSOFA score for the validation set of was 0.925. When the three indices were combined, the AUC was 0.817, the Hosmer–Lemeshow goodness-of-fit test showed χ² = 2.428 and p = .965. When children with sepsis are admitted to the ICU, we recommend performing rapid scoring and rapid bedside lactate and glucose testing to determine the early prognosis.

Keywords:

• Sepsis
• age-adjusted modified qSOFA
• 28-day all-cause mortality
• glucose
• lactate

Ethics approval

This study was approved by the Medical Ethics Committee of Henan Children’s Hospital (2023-K-032). Written informed consent was obtained from the parents or guardians of all study participants.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contributions

Made a substantial contribution to the conception and design, acquisition of data, and reviewed and revised the manuscript: Chunlan Song; Recruited patients and provided clinical data, analyzed the data, drafted the initial manuscript, and reviewed and revised the manuscript: Wanyu Jia; Collected data and conducted the initial analyses: Xue Zhang and Ruiyang Sun; Conceptualized and designed the study and critically reviewed the manuscript for important intellectual content: Peng Li; Critically reviewed the manuscript for important intellectual content and finally approved the version to be published: Daobin Wang; Critically reviewed the manuscript for important intellectual content and finally approved the version to be published: Xue Gu. All authors read and approved the final manuscript.

Data availability statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Additional information

Funding

This work was supported by the Henan Provincial Science and Technology Research Project (Grant number LHGJ20190926).