Assessing the prognostic accuracy of the PSS, pSOFA, and SIRS for in-hospital mortality in children with suspected infection in non-ICU settings: a multicenter retrospective study
Ruiying Liu, Xuanwen Ru, Zihao Yang, Tiewei Li, Junmei Yang, Yang Liu, Xiaoyu Cui, Jing Wu, Ruijie Yu, Zhan Ma, Baoyu Yuan, Feng Cheng, Suhong Huang, Caizhi Huang, Cong Zhang, Hongbing Chen, Xun Zhou, Xiao‐Wei Zhang, Jingran Wang, Xin Lv, Qian Zeng, Hong Zhu, Xuejun Shao, Feng Tang, Xuyang Gong, Ping Ling, Kun Chi, Guofeng Liu, Zhenwen Zhou, Xiaochun Liu, Qing Ye
Abstract
OBJECTIVES: To systematically compare the predictive accuracy of the Phoenix Sepsis Score (PSS), the Pediatric Sequential Organ Failure Assessment (pSOFA), and systemic inflammatory response syndrome (SIRS) in assessing in-hospital mortality risk among pediatric sepsis patients in non-intensive care unit (non-ICU) wards, thereby providing evidence-based support for clinical risk stratification. DESIGN: This study employed a multicenter retrospective cohort design, enrolling non-ICU pediatric patients with suspected infections (excluding preterm infants and neonates hospitalized immediately after birth), to construct an overall cohort and a neonatology subgroup cohort. Clinical parameters were collected through a data acquisition system, with parallel calculations of PSS, pSOFA, and SIRS scores. The primary endpoint was in-hospital mortality. Receiver operating characteristic (ROC) curves were constructed via R language version 4.3.1, and the discriminatory performance of each scoring system was evaluated via the area under the ROC curve (AUROC). RESULTS: From January 2023 to September 2024, 965 non-ICU pediatric patients with infections were enrolled from 13 medical centers (overall cohort mortality: 1.1%, 11/965; neonatology cohort: 193 cases, mortality: 4.1%, 8/193). In the overall cohort, all 11 patients experienced deterioration on the ward and were subsequently transferred to the pediatric intensive care unit (PICU) in accordance with each hospital's protocol; eight of them died from sepsis, and three from septic shock. After multivariate adjustment, the AUROC value of the PSS score in the overall cohort was 0.756 (99% CI: 0.731-0.780), representing a 3.6% improvement over the SIRS criteria (0.730, 99% CI: 0.543-0.873) but lower than the pSOFA score (0.845, 99% CI: 0.568-0.966). In the neonatology cohort, the AUROC value of the PSS score was 0.764 (99% CI: 0.478-0.927), comparable to that of the SIRS criteria (0.757, 99% CI: 0.475-0.905) but still lower than that of the pSOFA score (0.819, 99% CI: 0.533-0.983). No statistically significant differences were observed among the three scoring systems (P > 0.01). CONCLUSIONS: These findings suggest that the PSS score does not demonstrate superior predictive value compared with traditional assessment tools in non-ICU clinical scenarios.