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  • Clinical Research Article
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Predicting functional and quality-of-life outcomes following pediatric sepsis: performance of PRISM-III and PELOD-2

Pediatric Research volume 94, pages 1951–1957 (2023)Cite this article

Abstract

Background

Illness severity scores predict mortality following pediatric critical illness. Given declining PICU mortality, we assessed the ability of the Pediatric Risk of Mortality-III (PRISM) and Pediatric Logistic Organ Dysfunction-2 (PELOD) scores to predict morbidity outcomes.

Methods

Among 359 survivors <18 years in the Life After Pediatric Sepsis Evaluation multicenter prospective cohort study, we assessed functional morbidity at hospital discharge (Functional Status Scale increase ≥3 points from baseline) and health-related quality of life (HRQL; Pediatric Quality of Life Inventory or Functional Status II-R) deterioration >25% from baseline at 1, 3, 6, and 12 months post-admission. We determined discrimination of admission PRISM and admission, maximum, and cumulative 28-day PELOD with functional and HRQL morbidity at each timepoint.

Results

Cumulative PELOD provided the best discrimination of discharge functional morbidity (area under the receive operating characteristics curve [AUROC] 0.81, 95% CI 0.76–0.87) and 3-month HRQL deterioration (AUROC 0.71, 95% CI 0.61–0.81). Prediction was inferior for admission PRISM and PELOD and for 6- and 12-month HRQL assessments.

Conclusions

Illness severity scores have a good prediction of early functional morbidity but a more limited ability to predict longer-term HRQL. Identification of factors beyond illness severity that contribute to HRQL outcomes may offer opportunities for intervention to improve outcomes.

Impact

  • Illness severity scores are commonly used for mortality prediction and risk stratification in pediatric critical care research, quality improvement, and resource allocation algorithms.

  • Prediction of morbidity rather than mortality may be beneficial given declining pediatric intensive care unit mortality.

  • The PRISM and PELOD scores have moderate to good ability to predict new functional morbidity at hospital discharge following pediatric septic shock but limited ability to predict health-related quality of life outcomes in the year following PICU admission.

  • Further research is needed to identify additional factors beyond illness severity that may impact post-discharge health-related quality of life.

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Fig. 1: Prevalence of outcomes at each assessment timepoint.

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Data availability

The LAPSE dataset is available at the Eunice Kennedy Shriver NICHD Data and Specimen Hub (DASH): https://dash.nichd.nih.gov/explore/study?q=LAPSE&filters=[]&page=1&sortBy=relevance&asc=true&size=50.

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Acknowledgements

The investigators sincerely thank all patients and families who participated in this investigation. The following is a summary of study performance sites, Principal Investigators (PI), Co-investigators (CI), Research Coordinators (RC), and Allied Research Personnel. Children’s Hospital of Michigan, Detroit, MI: Kathleen L. Meert, MD (PI); Sabrina Heidemann, MD (CI); Ann Pawluszka, BSN, RN (RC); Melanie Lulic, BS (RC). Children’s Hospital of Philadelphia, Philadelphia, PA: Robert A. Berg, MD (PI); Athena Zuppa, MD, MSCE (PI); Carolann Twelves, RN, BSN (RC); Mary Ann DiLiberto, BS, RN, CCRC (RC). Children’s National Medical Center, Washington, DC: Murray Pollack, MD (PI); David Wessel, MD (PI); John Berger, MD (CI); Elyse Tomanio, BSN, RN (RC); Diane Hession, MSN, RN (RC); Ashley Wolfe, BS (RC). Children’s Hospital of Colorado, Denver, CO: Peter Mourani, MD (PI); Todd Carpenter, MD (CI); Diane Ladell, MPH, CCRC (RC); Yamila Sierra, MPH, BS (RC); Alle Rutebemberwa, MPH, BS (RC). Nationwide Children’s Hospital, Columbus, OH: Mark Hall, MD (PI); Andy Yates, MD (CI); Lisa Steele, RN, BSN, CCRC, CCRN (RC); Maggie Flowers, BSN (RC); Josey Hensley, RN (RC). Mattel Children’s Hospital, University of California Los Angeles, Los Angeles, CA: Anil Sapru, MD, MBBS, MAS (PI); Rick Harrison, MD (CI), Neda Ashtari, BS(RC); Anna Ratiu, MPH (RC). Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA: Joe Carcillo, MD (PI); Michael Bell, MD (CI); Leighann Koch, BS, BSN, RN (RC); Alan Abraham, CRC (RC). Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA: Patrick McQuillen, MD (PI); Anne McKenzie, BSN, CCRN (RC); Yensy Zetino, BS (RC). Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA: Christopher Newth, MD, FRCPC (PI); Jeni Kwok, JD, BS (RC); Amy Yamakawa, BS (RC). CS Mott Children’s Hospital, University of Michigan, Ann Arbor, MI: Michael Quasney, MD, PhD (PI); Thomas Shanley, MD (CI); C.J. Jayachandran, BS (RC). Cincinnati Children’s Hospital, Cincinnati, OH: Ranjit Chima, MD (PI); Hector Wong, MD (CI); Kelli Krallman, RN, BSN, MS, CCRC (RC); Erin Stoneman, CCRP (RC); Laura Benken, MBA, BS, CCRP (RC); Toni Yunger, BS (RC). St Louis Children’s Hospital, Washington University, St Louis, MO: Alan Doctor, RN, BSN (PI); Micki Eaton, RN, BSN (RC). Seattle Children’s Hospital, Seattle Children’s Research Institute (LAPSE Follow-up Center), University of Washington, Seattle, WA: Jerry J. Zimmerman, MD, PhD (PI); Catherine Chen, BS, CCRP (RC); Erin Sullivan, MPH (RC); Courtney Merritt, BA (RC); Deana Rich, BA (RC); Julie McGalliard, BA; Wren Haaland, MPH; Kathryn Whitlock, MS; Derek Salud, BS. University of Utah (Data Coordinating Center), Salt Lake City, UT: J. Michael Dean, MD, MBA (PI); Richard Holubkov, PhD (CI); Whit Coleman, MSRA, BSN, RN, CCRC (RC); Samuel Sorenson, BS (RC); Ron Reeder, PhD; Russell Banks, MS; Angie Webster, MStat; Jeri Burr, MS, RN-BC, CCRC; Stephanie Bisping, RN, BSN; Teresa Liu, MPH, CCRP; Emily Stock, BS; Kristi Flick, BS. Texas A&M University, College Station, TX: James W. Varni, PhD.

Funding

This study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development grants R03HD104001 (R.W.R.) and K23HD100566 (E.Y.K.). The LAPSE study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development grant R01HD073362, and was supported in part by the following cooperative agreements: UG1HD050096, UG1HD049981, UG1HD049983, UG1HD063108, UG1HD083171, UG1HD083166, UG1HD083170, U10HD050012, U10HD063106, and U01HD049934.

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Authors and Affiliations

  1. Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA

    Elizabeth Y. Killien, R. Scott Watson & Jerry J. Zimmerman

  2. Harborview Injury Prevention & Research Center, Seattle, WA, USA

    Elizabeth Y. Killien

  3. Center for Child Health, Behavior, & Development, Seattle Children’s Research Institute, Seattle, WA, USA

    R. Scott Watson

  4. University of Utah, Salt Lake City, UT, USA

    Russell K. Banks & Ron W. Reeder

  5. Division of Pediatric Critical Care Medicine, Children’s Hospital of Michigan, Detroit, MI, USA

    Kathleen L. Meert

  6. Central Michigan University, Mt. Pleasant, MI, USA

    Kathleen L. Meert

  7. Center for Clinical & Translational Research, Seattle Children’s Research Institute, Seattle, WA, USA

    Jerry J. Zimmerman

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  1. Elizabeth Y. Killien
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  2. R. Scott Watson
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  3. Russell K. Banks
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Contributions

E.Y.K.: conception and design, interpretation of data, article drafting, final manuscript approval. R.S.W.: conception and design, critical revisions for important intellectual content, final manuscript approval. R.K.B.: study design, data analysis, interpretation of data, final manuscript approval. R.W.R.: study design, data analysis, interpretation of data, final manuscript approval. K.L.M.: conception and design, acquisition of data, critical revisions for important intellectual content, final manuscript approval. J.J.Z.: conception and design, acquisition of data, critical revisions for important intellectual content, final manuscript approval.

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Correspondence to Elizabeth Y. Killien.

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Killien, E.Y., Watson, R.S., Banks, R.K. et al. Predicting functional and quality-of-life outcomes following pediatric sepsis: performance of PRISM-III and PELOD-2. Pediatr Res 94, 1951–1957 (2023). https://doi.org/10.1038/s41390-023-02619-w

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