A risk score based on pediatric sequential organ failure assessment predicts 90-day mortality in children with Klebsiella pneumoniae bloodstream infection

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  • Shuang Li, Shanghai Jiao Tong University
  • ,
  • Jingxian Liu, Shanghai Jiao Tong University
  • ,
  • Feng Chen, Shanghai Jiao Tong University
  • ,
  • Kang Cai, Shanghai Jiao Tong University
  • ,
  • Jintong Tan, Shanghai Jiao Tong University
  • ,
  • Wei Xie, Shanghai Jiao Tong University
  • ,
  • Rong Qian, Shanghai Jiao Tong University
  • ,
  • Xiaoqin Liu
  • Wenhong Zhang, Fudan University
  • ,
  • Huimin Du, Shanghai Jiao Tong University
  • ,
  • Ying Liu, Shanghai Jiao Tong University
  • ,
  • Lisu Huang, Shanghai Jiao Tong University

Background: Klebsiella pneumoniae bloodstream infection (Kp-BSI) is a serious threat to pediatric patients. The objective of this study was to explore the risk factors, validate the prediction efficiency of pediatric Sequential Organ Failure Assessment (SOFA) and establish better early predictors of mortality in pediatric patients with Kp-BSI. Methods: All children diagnosed with Kp-BSI were included in this retrospective cohort study from January 2009 to June 2019. Basic characteristics, symptoms and physical examinations, treatments, laboratory statistics, and SOFA at the onset of Kp-BSI were recorded. The Cox proportional hazard model and receiver operating characteristic curves were used to assess the association between the variables and the 90-day mortality and their predictive value. DeLong’s test of receiver operating characteristic curves and integrated discrimination improvement index were used to determine the improvement in predictive capacity of the modified SOFA models. A predictive score was developed using multivariate logistic regression. Results: Of the 146 children enrolled, 33 (22.6%) patients died within 90 days. Hospitalization in the last 6 months, intra-abdominal source of infection, presence of organ failure, and altered levels of blood biomarkers, including C-reactive protein, albumin, and lactate were significant risk factors for 90-day mortality. The area under the curve (AUC) of SOFA for predicting 90-day mortality was 0.80 (95% CI 0.71–0.89). Moreover, we found that a prediction model combining SOFA with two other parameters, namely hospitalization in the last 6 months and intra-abdominal source of infection, was better at predicting mortality (AUC = 0.89, 95% CI 0.82–0.96; sensitivity = 0.86; specificity = 0.84). According to this novel risk model, we defined three statistically different groups: low-risk, medium-risk and high-risk groups, with an observed 90-day mortality of 5.4, 35.7, and 72.0%, respectively. With reference to the low-risk patients, the medium-risk and high-risk groups had a higher mortality, with hazard ratios of 8.36 (95% CI 3.60–27.83) and 20.27 (95% CI 7.47–54.95), respectively. Conclusions: The modified SOFA may be better than the original score to predict 90-day mortality in pediatric patients with Kp-BSI. Future prospective studies are required to validate this novel scoring system in external cohorts.

OriginalsprogEngelsk
Artikelnummer916
TidsskriftBMC Infectious Diseases
Vol/bind20
ISSN1471-2334
DOI
StatusUdgivet - dec. 2020

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