Objective: To investigate the value of systemic inflammatory response syndrome (SIRS), pediatric sequential organ failure assessment (pSOFA) and pediatric critical illness score (PCIS) in predicting mortality of pediatric sepsis in pediatric intensive care units (PICU) from Southwest China. Methods: This was a prospective multicenter observational study. A total of 447 children with sepsis admitted to 12 PICU in Southwest China from April 2022 to March 2023 were enrolled. Based on the prognosis, the patients were divided into survival group and non-survival group. The physiological parameters of SIRS, pSOFA and PCIS were recorded and scored within 24 h after PICU admission. The general clinical data and some laboratory results were recorded. The area under the curve (AUC) of the receiver operating characteristic curve was used to compare the predictive value of SIRS, pSOFA and PCIS in mortality of pediatric sepsis. Results: Amongst 447 children with sepsis, 260 patients were male and 187 patients were female, aged 2.5 (0.8, 7.0) years, 405 patients were in the survival group and 42 patients were in the non-survival group. 418 patients (93.5%) met the criteria of SIRS, and 440 patients (98.4%) met the criteria of pSOFA≥2. There was no significant difference in the number of items meeting the SIRS criteria between the survival group and the non-survival group (3(2, 4) vs. 3(3, 4) points, Z=1.30, P=0.192). The pSOFA score of the non-survival group was significantly higher than that of the survival group (9(6, 12) vs. 4(3, 7) points, Z=6.56, P<0.001), and the PCIS score was significantly lower than that of the survival group (72(68, 81) vs. 82(76, 88) points, Z=5.90, P<0.001). The predictive value of pSOFA (AUC=0.82) and PCIS (AUC=0.78) for sepsis mortality was significantly higher than that of SIRS (AUC=0.56) (Z=6.59, 4.23, both P<0.001). There was no significant difference between pSOFA and PCIS (Z=1.35, P=0.176). Platelet count, procalcitonin, lactic acid, albumin, creatinine, total bilirubin, activated partial thromboplastin time, prothrombin time and international normalized ratio were all able to predict mortality of sepsis to a certain degree (AUC=0.64, 0.68, 0.80, 0.64, 0.68, 0.60, 0.77, 0.75, 0.76, all P<0.05). Conclusion: Compared with SIRS, both pSOFA and PCIS had better predictive value in the mortality of pediatric sepsis in PICU.
目的： 评估全身炎症反应综合征（SIRS）标准、儿童序贯器官衰竭评分（pSOFA）和小儿危重病例评分（PCIS）对中国西南地区儿童重症监护病房（PICU）中儿童脓毒症病死率的预测价值。 方法： 前瞻性多中心观察性研究。以2022年4月至2023年3月收入中国西南地区12个PICU诊断为脓毒症的447例患儿为研究对象。根据出PICU时转归分为存活组和死亡组，在患儿入PICU 24 h内记录SIRS、pSOFA和PCIS的相关生理学参数并评分，比较一般临床资料和部分实验室检查结果。使用受试者工作特征曲线曲线下面积（AUC）比较SIRS标准、pSOFA和PCIS对儿童脓毒症病死率的预测价值。 结果： 447例脓毒症患儿男260例、女187例，年龄2.5（0.8，7.0）岁。存活组405例，死亡组42例。418例（93.5%）符合儿童SIRS标准，440例（98.4%）符合pSOFA≥2分标准。符合SIRS标准的条目数量在存活组和死亡组之间差异无统计学意义［3（2，4）比3（3，4）分，Z=1.30，P=0.192］；死亡组的pSOFA分数显著高于存活组［9（6，12）比4（3，7）分，Z=6.56，P<0.001］，PCIS评分显著低于存活组［72（68，81）比82（76，88）分，Z=5.90，P<0.001］。pSOFA（AUC=0.82）和PCIS（AUC=0.78）对脓毒症病死率的预测价值均显著高于SIRS标准（AUC=0.56）（Z=6.59、4.23，均P<0.001）；pSOFA与PCIS比较差异无统计学意义（Z=1.35，P=0.176）。血小板计数、降钙素原、血乳酸、白蛋白、肌酐、总胆红素、活化部分凝血活酶时间、凝血酶原时间和国际标准化比值对脓毒症病死率也均有一定的预测价值（AUC=0.64、0.68、0.80、0.64、0.68、0.60、0.77、0.75、0.76，均P<0.05）。 结论： 与SIRS相比，pSOFA和PCIS在PICU儿童脓毒症病死率方面均具有较好的预测价值。.