Testing the Prognostic Accuracy of the Updated Pediatric Sepsis Biomarker Risk Model

被引：55

作者：

Wong, Hector R. ^{[1
,2
,3
]}

Weiss, Scott L. ^{[4
]}

Giuliano, John S., Jr. ^{[5
]}

Wainwright, Mark S. ^{[6
]}

Cvijanovich, Natalie Z. ^{[7
]}

Thomas, Neal J. ^{[8
]}

Allen, Geoffrey L. ^{[9
]}

Anas, Nick ^{[10
]}

Bigham, Michael T. ^{[11
]}

Hall, Mark ^{[12
]}

Freishtat, Robert J. ^{[13
]}

Sen, Anita ^{[14
]}

Meyer, Keith ^{[15
]}

Checchia, Paul A. ^{[16
]}

Shanley, Thomas P. ^{[17
]}

Nowak, Jeffrey ^{[18
]}

Quasney, Michael ^{[17
]}

Chopra, Arun ^{[19
]}

Fitzgerald, Julie C. ^{[4
]}

Gedeit, Rainer ^{[20
]}

Banschbach, Sharon ^{[1
,2
]}

Beckman, Eileen ^{[1
,2
]}

Lahni, Patrick ^{[1
,2
]}

Hart, Kimberly ^{[21
]}

Lindsell, Christopher J. ^{[21
]}

机构：

[1] Cincinnati Childrens Hosp Med Ctr, Div Crit Care Med, Cincinnati, OH 45229 USA

[2] Cincinnati Childrens Res Fdn, Cincinnati, OH 45229 USA

[3] Univ Cincinnati Coll Med, Dept Pediat, Cincinnati, OH USA

[4] Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA

[5] Yale Univ, Sch Med, Dept Pediat, Div Crit Care Med, New Haven, CT USA

[6] Ann & Robert H Lurie Childrens Hosp Chicago, Chicago, IL USA

[7] Childrens Hosp & Res Ctr Oakland, Oakland, CA USA

[8] Penn State Hershey Childrens Hosp, Hershey, PA USA

[9] Childrens Mercy Hosp, Kansas City, MO 64108 USA

[10] Childrens Hosp Orange Cty, Orange, CA 92668 USA

[11] Akron Childrens Hosp, Akron, OH USA

[12] Nationwide Childrens Hosp, Columbus, OH USA

[13] Childrens Natl Med Ctr, Washington, DC 20010 USA

[14] Columbia Univ, Med Ctr, Morgan Stanley Childrens Hosp, New York, NY USA

[15] Miami Childrens Hosp, Miami, FL USA

[16] Texas Childrens Hosp, Houston, TX 77030 USA

[17] Univ Michigan, CS Mott Childrens Hosp, Ann Arbor, MI 48109 USA

[18] Childrens Hosp & Clin Minnesota, Minneapolis, MN USA

[19] St Christophers Hosp Children, Philadelphia, PA 19133 USA

[20] Childrens Hosp Wisconsin, Milwaukee, WI USA

[21] Univ Cincinnati, Coll Med, Dept Emergency Med, Cincinnati, OH USA

来源：

PLOS ONE | 2014年 / 9卷 / 01期

基金：

美国国家卫生研究院;

关键词：

EXPRESSION PROFILES; IDENTIFICATION;

D O I：

10.1371/journal.pone.0086242

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Background: We previously derived and validated a risk model to estimate mortality probability in children with septic shock (PERSEVERE; PEdiatRic SEpsis biomarkEr Risk modEl). PERSEVERE uses five biomarkers and age to estimate mortality probability. After the initial derivation and validation of PERSEVERE, we combined the derivation and validation cohorts (n = 355) and updated PERSEVERE. An important step in the development of updated risk models is to test their accuracy using an independent test cohort. Objective: To test the prognostic accuracy of the updated version PERSEVERE in an independent test cohort. Methods: Study subjects were recruited from multiple pediatric intensive care units in the United States. Biomarkers were measured in 182 pediatric subjects with septic shock using serum samples obtained during the first 24 hours of presentation. The accuracy of PERSEVERE 28-day mortality risk estimate was tested using diagnostic test statistics, and the net reclassification improvement (NRI) was used to test whether PERSEVERE adds information to a physiology-based scoring system. Results: Mortality in the test cohort was 13.2%. Using a risk cut-off of 2.5%, the sensitivity of PERSEVERE for mortality was 83% (95% CI 62-95), specificity was 75% (68-82), positive predictive value was 34% (22-47), and negative predictive value was 97% (91-99). The area under the receiver operating characteristic curve was 0.81 (0.70-0.92). The false positive subjects had a greater degree of organ failure burden and longer intensive care unit length of stay, compared to the true negative subjects. When adding PERSEVERE to a physiology-based scoring system, the net reclassification improvement was 0.91 (0.47-1.35; p<0.001). Conclusions: The updated version of PERSEVERE estimates mortality probability reliably in a heterogeneous test cohort of children with septic shock and provides information over and above a physiology-based scoring system.

引用

页数：6

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