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A new scoring system derived from base excess and platelet count at presentation predicts mortality in paediatric meningococcal sepsis.

Couto-Alves A, Wright VJ, Perumal K, Binder A, Carrol ED, Emonts M, de Groot R, Hazelzet J, Kuijpers T, Nadel S, Zenz W, Ramnarayan P, Levin M, Coin L, Inwald DP - Crit Care (2013)

Bottom Line: 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.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).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.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

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.

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Contour plot showing the probability of death for different ranges of base excess and platelet count (BEP) score. Notice for BEP > 0.15, the probability of death increases progressively for the same change in the variables.
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Figure 2: Contour plot showing the probability of death for different ranges of base excess and platelet count (BEP) score. Notice for BEP > 0.15, the probability of death increases progressively for the same change in the variables.

Mentions: The performance of the BEP score for a range of cutoffs ((0.1 to 0.5)) was estimated on the development, validation and replication datasets (Table 4). For a cutoff as low as BEP > 0.3 a good discriminating performance can be achieved on all datasets positive predictive value ((PPV) > 0.5, negative predictive value (NPV) > 0.94). A contour plot of the BEP score probability of death as a function of BE and platelet count is shown for quick reference (Figure 2). The cutoff Θ that maximizes the Youden's statistic was estimated on the development dataset using the following equation: Θ = arg max (Sensitivity (Θ) + Specificity (Θ) -1). The cutoff was then applied to the validation and replication dataset and results are presented in Table S1 (Table S1 in Additional file 4). Overall, a good performance was consistently obtained in the validation and development datasets. Sensitivity confidence intervals obtained in the validation dataset includes the point estimates of the development dataset. Specificity confidence intervals obtained in development and validation datasets overlap and PPV was higher in the validation and replication dataset.


A new scoring system derived from base excess and platelet count at presentation predicts mortality in paediatric meningococcal sepsis.

Couto-Alves A, Wright VJ, Perumal K, Binder A, Carrol ED, Emonts M, de Groot R, Hazelzet J, Kuijpers T, Nadel S, Zenz W, Ramnarayan P, Levin M, Coin L, Inwald DP - Crit Care (2013)

Contour plot showing the probability of death for different ranges of base excess and platelet count (BEP) score. Notice for BEP > 0.15, the probability of death increases progressively for the same change in the variables.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3672696&req=5

Figure 2: Contour plot showing the probability of death for different ranges of base excess and platelet count (BEP) score. Notice for BEP > 0.15, the probability of death increases progressively for the same change in the variables.
Mentions: The performance of the BEP score for a range of cutoffs ((0.1 to 0.5)) was estimated on the development, validation and replication datasets (Table 4). For a cutoff as low as BEP > 0.3 a good discriminating performance can be achieved on all datasets positive predictive value ((PPV) > 0.5, negative predictive value (NPV) > 0.94). A contour plot of the BEP score probability of death as a function of BE and platelet count is shown for quick reference (Figure 2). The cutoff Θ that maximizes the Youden's statistic was estimated on the development dataset using the following equation: Θ = arg max (Sensitivity (Θ) + Specificity (Θ) -1). The cutoff was then applied to the validation and replication dataset and results are presented in Table S1 (Table S1 in Additional file 4). Overall, a good performance was consistently obtained in the validation and development datasets. Sensitivity confidence intervals obtained in the validation dataset includes the point estimates of the development dataset. Specificity confidence intervals obtained in development and validation datasets overlap and PPV was higher in the validation and replication dataset.

Bottom Line: 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.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).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.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus