Prediction of mortality on seventh day with PELOD scoring on day-0 and day-2 in children with multi organ dysfunction syndrome in a tertiary care PICU

R. Uma Devi; B Kannaiah; P Srinivas; Sravanthi Veldandi; Razi Mohammad

doi:10.53730/ijhs.v6nS4.11031

Authors

R. Uma Devi Professor, Department of Pediatrics, Niloufer Hospital, Hyderabad
Kannaiah B Assistant Professor, Department of Pediatrics, Government medical college, Nizamabad
Srinivas P Professor, Department of Pediatrics, Government medical college, Nizamabad
Sravanthi Veldandi Assistant Professor in Pediatrics, Niloufer Hospital, Hyderabad
Razi Mohammad Post graduate, Department of Pediatrics, Niloufer hospital

Keywords:

multi organ dysfunction syndrome (MODS), severe inflammatory response system (SIRS), pediatric logistic organ dysfunction score (PELOD), mortality

Abstract

Background: In a PICU set up the reported incidence of MODS is 11-56% and the Odds of death in children with MODS 11.3. In a resource limited setting, mortality prediction becomes important within the first 3 days of PICU stay for financial burden plays a big role in these decisions. The PELOD score has been validated as an outcome measure when recorded daily. In this study, validation of the PELOD score on just 2 days i.e. at baseline (day 0) and after 48hrs (day 2) and the difference between the two was studied to predict short term mortality as an outcome by the end of 7 days. Aim: Prediction of mortality on seventh day with PELOD scoring on Day-0 and Day-2 in children with Multi Organ Dysfunction Syndrome in a tertiary care PICU. Materials & Methods: A prospective longitudinal observational cohort study was carried out in a 20 bedded Indian PICU. Inclusion criteria included children age 1 month to 12 years, the presence of MODS and a PICU stay > 24 hrs. Once an inclusion criterion is met data was collected from the patients in PICU & entered in EXCEL 2013 for calculation of PELOD & PRSIM.

Downloads

Download data is not yet available.

References

Fuhrman BP, Zimmerman JJ. Pediatric multi organ dysfunction syndrome in Pediatric Critical Care. 4th Ed. Philadelphia: Elsevier Saunders; 2011. Chapter 97: p 1494-05.

Al-Khafaji AH, Sharma S. Multiorgan dysfunction syndrome in Sepsis. [internet] 2010. [updated 2012 april 12; cited 2010 aug 14 Available from: http://emedicine.medscape.com/article/169640-overview

The American College Of Chest Physicians/Society Of Critical Care Medicine Consensus Conference: definition of sepsis and organ failure guidelines for the use of innovative therapies in sepsis. Crit Care Med, 1992 Jun; 20(6):864-74.

Opal SM. Concept of PIRO as a new conceptual framework to understand sepsis. Pediatr Crit Care Med. 2005 May; 6(3 suppl): S55-S60.

Vincent JL, Wendon J, Groeneveld J, Marshall JC, Streat S, Carlet J. The PIRO concept: O is for organ dysfunction. Crit care. 2003Jun;7(3):260–4.

Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the united states from 1979 through 2000. N Eng J Med 2003Apr;348(16):1546-54.

Rangel-Fraustro MS, Pittet D, Costigan M, Hwang T, Davis CS,Wenzel RP. The natural history of systemic inflammatory response syndrome (SIRS): A Prospective Study . JAMA 1995 Jan;273(2):117-23.

Vallet B. Bench - to bedside review : Endothelial cell dysfunction in severe sepsis. A role in organ dysfunction? Crit Care 2003 Apr; 7(2):130-8.

Meharban Singh. Multi organ dysfunction syndrome in Medical Emergencies In Children. 4th Ed. Sagar publications; 2007. Chapter 39,p531-43.

Top AP, Tasken RC, Ince C. The microcirculation of the critically ill pediatric patient. Critical Care2011Mar;15(2):213.

Trzeciak S, Dellinger RP, Parrillo JE, Guglielmi M, BajajJ, Abate NL, et al. Early microcirculatory perfusion derangements in patients with severe sepsis and septic shock: relationship to hemodynamics, oxygen transport, and survival. Ann Emerg Med. 2007Jan;49(1):88–98.

Doughty L, Clark RS, Kaplan SS, Sasser H, Carcillo J. sFas and sFas ligand and pediatric sepsis-induced multiple organ failure syndrome. Pediatr Res. 2002 Dec;52(6):922-7.

Proulx F, FayonM, Farrell CA, Lacroix J, Gauthier M. Epidemiology and sepsis and multiple organ dysfunction in children. Chest 1996 Apr;109(4):1033-7.

Lacroix J, Cotting J. Severity of illness and organ dysfunction scoring in children. Pediatr Crit Care Med. 2005 May, 6(3 suppl):S126-134.

Vincent JL, Ferreira F, Moreno R. Scoring systems for assessing organ dysfunction and survival. Crit Care Clin. 2000Apr;16(2):353–66.

DiCarlo J, Frankel LR. Scori ng systems and predictors of mortality in Nelson Textbook Of Pediatrics. 18th Ed. Philadelphia: Elsevier; 2007, Chapter 65, p387.

Pollack MM, Patel KM, Ruttiman URSE. PRISM ш: An updated pediatric list of mortality score. Crit Care Med. 1996 May;24(5):743-52.

Pollack MM, Patel KM, Ruttimann UE. PRISM III. An updated pediatric list of mortality score. Crit Care Med. 1996May;24(5):743-52.

Wells M, Riera-Fanego JF, LuytDK, Dance M, Lipman J. Poor discriminative capacity of the pediatric risk of mortality (PRISM) score in a south African intensive care unit. Crit Care Med. 1996Sep;24(9):1507-13.

GarciaPC,EulmesekianP,BrancoRG,PerezA,SffogiaA,OliveroL,etal. External validation of the pediatric logistic organ dysfunction score. Intensive Care Med. 2010Jan;36(1):116–21

Metta D, Soebardja D, Soemasetia DH. The use of Pediatric Logistic Organ Dysfunction (PELOD) scoring system to determine the prognosis of patients in pediatric intensive care units. PediatrIndones.2006;46:1 -6.

Dewi LP, Nurfitri E. Pediatric logistic organ dysfunction score as a predictive tool of dengue shock syndrome outcomes. Pediatric In dones. 2012Mar;52(2):72-7

Khilnani P, Sarma D, Zimmerman J. Epidemiology and peculiarities of pediatric multiple organ dysfunction syndrome in New Delhi, India. Intensive Care Med. 2006Nov;32(11):1856-62.

Wagner DP, Knaus WA, Harrell FE, Zimmerman JE, Watts C. Daily prognostic estimates for critically ill adults in intensive care units: results from a prospective, multicenter, inception cohort analysis. Crit Care Med.1994Sep;22(9):1359-72.

Timsit JF, Fosse JP, Troche G, De Lassence A, Alberti C, Garrouste-Orgeas M, et al. Calibration and discrimination by daily Logistic Organ Dysfunction scoring comparatively with daily Sequential Organ Failure Assessment scoring for predicting hospital mortality in critically ill patients. Crit Care Med. 2002 Sep;30(9):2003-13.

Ferreira FL, Bota DP, Bross A, et al. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001Oct;286|(15):1754-8.

Garcia PC, Eulmesekian P, Sffogia A, Perez A, Branco RG, Piva JP, etal. Limitation in paediatric logistic organ dysfunction score. Lancet. 2006 Sep 30;368(9542):1151-2

Leclerc F, Leteurtre S, Duhamel A, et al. Cumulative influence of organ dysfunction and septic state on mortality of critically ill children. Am J Respir Crit Care Med. 2005 Feb;171(4):348-53.

Typpo KV, Petersen NJ, Hallman DM, Markovitz BP, Mariscalco MM. Day 1multiple organ dysfunction syndrome is associated with poor functional outcome and mortality in the pediatric intensive care unit. Pediatr Crit Care Med. 2009 Sep;10(5):562-70.

Proulx F, Joyal JS, Mariscalco MM, Leteurtre S, Leclerc F, Lacroix Jet. The pediatric multiple organ dysfunction syndrome. Pediatr Crit Care Med. 2009 Jan;10(1):12 -22.

Proulx F, Gautheir M, Nadeau D, Lacroix J, Farrell CA. Timing and predictors of death in pediatric patients with multiple organ system failure. Crit Care Med. 1994 Jun; 22(6):1025-31.

Marshall JC. Modeling MODS: What can be learned from animal models of the multiple-organ dysfunction syndrome? Intensive Care Med. 2005May; 31(5):605- 8.

Wilkinson JD, Pollack MM, Glass NL, Kanter RK, Katz RW, Steinhart CM. Mortality associated with multiple organ system failure and sepsis in pediatric intensive care unit. J Pediatr. 1987Sept;111(3):324 -8.

Cengiz P, Zimmerman J J. Prelude to pediatric multiple organ dysfunction syndrome: the golden hours concept revisited. Pediatr Crit Care Med. 2003 Apr; 4(2):263-4.

Tantalean JA, Leon RJ, Santos AA, Sanchez E . Multiple organ dysfunction syndrome in children. Pediatr Crit Care Med. 2003 Apr;4(2):181-5.

LaclereF,LeteurtreS,DuhamelA,GrandbastienB,ProulxF,MartinotA,etal. Cumulative influence of organ dysfunction and septic state on mortality of critically ill children. Am J Respir Crit Care Med. 2005 Feb;171(4):348-53.

LeteurtreS,MartinotA,DuhamelA,GauvinF,GrandbasteinB,NamTV,etal. Development of a pediatric multiple organ dysfunction score: use of 2 strategies. Med Decis Making. 1999;19:339- 410.

Wilkinson JD, Pollack MM, Ruttiman UE, Glass NL,Yeh TS. Outcome of pediatric patients with multiple organ system failure . Crit Care Med. 1986 Apr;14(4):271-4.

Tan GH, Tan TH, Goh DY, Yap HK. Risk Factors for Predicting Mortality in a Paediatric Intensive Care Unit . Ann Acad Med Singapore. 1998Nov;27(6):813-8. 86

LeteurtreS,MartinotA,DuhamelA,ProulxF,GrandbastienB,CottingJ,etal. Validation of pediatric organ dysfunction score; Prospective observational multicentric study. Lancet. 2003 Jul;362(9379):1927.

Goh A,LumL.Sepsis,severe sepsis and septic shock in pediatric multiple organ dysfunction syndrome. J Pedriatr Child Health. 1999Oct;35(5)488-92.

Leteurtre S, Duhamel A, Grandbastien B, Proulx F, Cotting J, Gottesman R,etal. Daily estimation of the severity of multiple organ dysfunction syndrome in critically ill children. Can.Med.Assoc.J. 2010 Aug;182(11):1181-7.

Thukral A, Kohli U, Lodha R, Kabra SK, Kabra NK. Validation of the PELOD Score for Multiple Organ Dysfunction in Children. Indian Pediatr2007 Sep;44(9):683-6

Goldstein B, Giroir B, Randolph A, International consensus conference on pediatric sepsis. International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. Jan 2005;6(1):28.

Despond O, Proulx F, Carcillo JA, Lacroix J. Pediatric sepsis and multiple organ dysfunction syndrome. CurrOpinPediatr. 2001Jun;13(3):247-53.

Livingston DH, Monsenthal AC, Deitch EA. Sepsis and multiple organ dysfunction syndrome. A clinical mechanistic overview. New Horiz.1995 May;3(2):257-66.

Balk R A. Pathogenesis and management of multiple organ dysfunction or failure in severe sepsis and septic shock. Crit Care Clin. 2000Apr;16(2):337-52.

Bone RC et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine 1992. Chest. 2009Nov;136(5Suppl):28

Bone RC. Sir Issac Newton, sepsis, SIRS and CARS. Crit Care Med. 1996 Jul;24(7):1125-8.

Leteurtre S, Duhamel A, Grandbastien B, Lacroix J, Leclerc F . Pediatric logistic organ dysfunction (PELOD) score . Lancet 2006Mar;367(9514):897.

Garcia PC, Eulmesekian P, Branco RG, Perez A, Sffogia A, Olivero L, etal. External validation of the pediatric logistic organ dysfunction score. Intensive Care Med. 2010 Jan ;36(1):116-22.

Minne J, Abu-Hanna A, De Jonge E. Evaluation of SOFA-based models for predicting mortality in the ICU: A systematic review.CriticalCare2008,12:R161 (doi:10.1186/cc7160) Available onlinehttp://ccforum.com/content/12/6/R161

Han YY, Shanley TP. Multiple Organ Dysfunction Syndrome in Roger’s Textbook Of Pediatric Intensive Care. 4th Ed. Philadelphia: Lippincott Williams & Wilkins. 2008. Chapter 21: p283-302.

Sofija, G., & Ivan, T. (2018). Quality of life in children with disabilities placed in foster families. International Journal of Health & Medical Sciences, 1(1), 18-27. https://doi.org/10.31295/ijhms.v1n1.35

Suryasa, I. W., Rodríguez-Gámez, M., & Koldoris, T. (2021). Get vaccinated when it is your turn and follow the local guidelines. International Journal of Health Sciences, 5(3), x-xv. https://doi.org/10.53730/ijhs.v5n3.2938