The clinical and biomarker approach to predict sepsis mortality in pediatric patients

Background Sepsis is a leading cause of pediatric morbidity and mortality. The prevalence of sepsis mortality in Indonesia varies between 22.5 to 52%. Objective To identify the clinical criteria for predicting sepsis mortality and evaluate the performance of the PELOD-2 score. Methods This retrospective cohort study included pediatric patients admitted to the emergency department or pediatric in-tensive care unit (PICU) of Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from January 2015 to May 2020. Demographic characteristics (age and sex), clinical manifestations [nutritional status, presence of shock, need for intubation, source of infection, inotrope use, mean arterial pressure, pulse rate, respiratory rate, and Glasgow Coma Scale (GCS) score], laboratory [leukocyte, platelet, neutrophil, and lymphocyte counts, neutrophil-to-lymphocyte count ratio (NLCR), procalcitonin, C-reactive protein (CRP), and lactate profile], PELOD-2 score, and mortality data were recorded as outcomes. Results We analyzed data from 241 sepsis subjects. The overall mortality rate was 65%. Shock [OR 3.2; 95%CI 1.80 to-5.55; P<0.001)], GCS <9 [OR 2.4; 95%CI 1.30 to 4.23; P=0.005)], inotrope use [OR 3.1; 95%CI 1.74 to 5.5; P<0.001)], CRP >33.5 mg/L [OR 2.5; 95%CI 1.14 to 5.35; P=0.02)], and lactate level >2.85 [OR 2.1 (95%CI 1.02 to 4.56, P=0.04)] were considered significant predictors of mortality. A PELOD-2 cut-off score of >8 had optimal sensitivity (81.2%) and specificity (72.9%) to predict mortality, with an OR of 11.6 (95%CI 5.72 to 23.5; P<0.001). Conclusion Shock, GCS score, inotrope use, CRP, and lactate level can serve as clinical biomarkers to predict mortality in pediatric sep-sis. A PELOD-2 score of >8 can predict mortality with reasonably good sensitivity and specificity. [Paediatr Indones. 2023;63:37-44;