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A new scoring system derived from base excess and platelet count at presentation predicts mortality in paediatric meningococcal sepsis
INTRODUCTION: The aim of this study was to derive a novel prognostic score for mortality in paediatric meningococcal sepsis (MS) based on readily available laboratory markers. METHODS: A multicentre retrospective cohort study for the consortium set and a single centre retrospective study for replica...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672696/ https://www.ncbi.nlm.nih.gov/pubmed/23577792 http://dx.doi.org/10.1186/cc12609 |
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author | Couto-Alves, Alexessander Wright, Victoria J Perumal, Karnan Binder, Alexander Carrol, Enitan D Emonts, Marieke de Groot, Ronald Hazelzet, Jan Kuijpers, Taco Nadel, Simon Zenz, Werner Ramnarayan, Padmanabhan Levin, Michael Coin, Lachlan Inwald, David P |
author_facet | Couto-Alves, Alexessander Wright, Victoria J Perumal, Karnan Binder, Alexander Carrol, Enitan D Emonts, Marieke de Groot, Ronald Hazelzet, Jan Kuijpers, Taco Nadel, Simon Zenz, Werner Ramnarayan, Padmanabhan Levin, Michael Coin, Lachlan Inwald, David P |
author_sort | Couto-Alves, Alexessander |
collection | PubMed |
description | INTRODUCTION: The aim of this study was to derive a novel prognostic score for mortality in paediatric meningococcal sepsis (MS) based on readily available laboratory markers. METHODS: A multicentre retrospective cohort study for the consortium set and a single centre retrospective study for replication set. The consortium set were 1,073 children (age 1 week to 17.9 years) referred over a 15-year period (1996 to 2011), who had an admission diagnosis of MS, referred to paediatric intensive care units (PICUs) in six different European centres. The consortium set was split into a development set and validation set to derive the score. The replication set were 134 children with MS (age 2 weeks to 16 years) referred over a 4-year period (2007 to 2011) to PICUs via the Children's Acute Transport Service (CATS), London. RESULTS: A total of 85/1,073 (7.9%) children in the consortium set died. A total of 16/134 (11.9%) children in the replication set died. Children dying in the consortium set had significantly lower base excess, C-reactive protein (CRP), platelet and white cell count, more deranged coagulation and higher lactate than survivors. Paediatric risk of mortality (PRISM) score, Glasgow meningococcal septicaemia prognosis score (GMSPS) and Rotterdam score were also higher. Using the consortium set, a new scoring system using base excess and platelet count at presentation, termed the BEP score, was mathematically developed and validated. BEP predicted mortality with high sensitivity and specificity scores (area under the curve (AUC) in the validation set = 0.86 and in the replication set = 0.96). In the validation set, BEP score performance (AUC = 0.86, confidence interval (CI): 0.80 to 0.91) was better than GMSPS (AUC = 0.77, CI: 0.68, 0.85), similar to Rotterdam (AUC = 0.87, CI: 0.81 to 0.93) and not as good as PRISM (AUC = 0.93, CI: 0.85 to 0.97). CONCLUSIONS: The BEP score, relying on only two variables that are quickly and objectively measurable and readily available at presentation, is highly sensitive and specific in predicting death from MS in childhood. |
format | Online Article Text |
id | pubmed-3672696 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-36726962013-06-06 A new scoring system derived from base excess and platelet count at presentation predicts mortality in paediatric meningococcal sepsis Couto-Alves, Alexessander Wright, Victoria J Perumal, Karnan Binder, Alexander Carrol, Enitan D Emonts, Marieke de Groot, Ronald Hazelzet, Jan Kuijpers, Taco Nadel, Simon Zenz, Werner Ramnarayan, Padmanabhan Levin, Michael Coin, Lachlan Inwald, David P Crit Care Research INTRODUCTION: The aim of this study was to derive a novel prognostic score for mortality in paediatric meningococcal sepsis (MS) based on readily available laboratory markers. METHODS: A multicentre retrospective cohort study for the consortium set and a single centre retrospective study for replication set. The consortium set were 1,073 children (age 1 week to 17.9 years) referred over a 15-year period (1996 to 2011), who had an admission diagnosis of MS, referred to paediatric intensive care units (PICUs) in six different European centres. The consortium set was split into a development set and validation set to derive the score. The replication set were 134 children with MS (age 2 weeks to 16 years) referred over a 4-year period (2007 to 2011) to PICUs via the Children's Acute Transport Service (CATS), London. RESULTS: A total of 85/1,073 (7.9%) children in the consortium set died. A total of 16/134 (11.9%) children in the replication set died. Children dying in the consortium set had significantly lower base excess, C-reactive protein (CRP), platelet and white cell count, more deranged coagulation and higher lactate than survivors. Paediatric risk of mortality (PRISM) score, Glasgow meningococcal septicaemia prognosis score (GMSPS) and Rotterdam score were also higher. Using the consortium set, a new scoring system using base excess and platelet count at presentation, termed the BEP score, was mathematically developed and validated. BEP predicted mortality with high sensitivity and specificity scores (area under the curve (AUC) in the validation set = 0.86 and in the replication set = 0.96). In the validation set, BEP score performance (AUC = 0.86, confidence interval (CI): 0.80 to 0.91) was better than GMSPS (AUC = 0.77, CI: 0.68, 0.85), similar to Rotterdam (AUC = 0.87, CI: 0.81 to 0.93) and not as good as PRISM (AUC = 0.93, CI: 0.85 to 0.97). CONCLUSIONS: The BEP score, relying on only two variables that are quickly and objectively measurable and readily available at presentation, is highly sensitive and specific in predicting death from MS in childhood. BioMed Central 2013 2013-04-11 /pmc/articles/PMC3672696/ /pubmed/23577792 http://dx.doi.org/10.1186/cc12609 Text en Copyright © 2013 Couto-Alves et al.; licensee BioMed Central Ltd http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Couto-Alves, Alexessander Wright, Victoria J Perumal, Karnan Binder, Alexander Carrol, Enitan D Emonts, Marieke de Groot, Ronald Hazelzet, Jan Kuijpers, Taco Nadel, Simon Zenz, Werner Ramnarayan, Padmanabhan Levin, Michael Coin, Lachlan Inwald, David P A new scoring system derived from base excess and platelet count at presentation predicts mortality in paediatric meningococcal sepsis |
title | A new scoring system derived from base excess and platelet count at presentation predicts mortality in paediatric meningococcal sepsis |
title_full | A new scoring system derived from base excess and platelet count at presentation predicts mortality in paediatric meningococcal sepsis |
title_fullStr | A new scoring system derived from base excess and platelet count at presentation predicts mortality in paediatric meningococcal sepsis |
title_full_unstemmed | A new scoring system derived from base excess and platelet count at presentation predicts mortality in paediatric meningococcal sepsis |
title_short | A new scoring system derived from base excess and platelet count at presentation predicts mortality in paediatric meningococcal sepsis |
title_sort | new scoring system derived from base excess and platelet count at presentation predicts mortality in paediatric meningococcal sepsis |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672696/ https://www.ncbi.nlm.nih.gov/pubmed/23577792 http://dx.doi.org/10.1186/cc12609 |
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