Severity of organ dysfunction in pediatric intensive care using PELOD-۲

Objective: Organ dysfunction is an important factor determining the severity and outcome of critical illness in children. Organ dysfunction scores are based on the number of organs involved and the severity of dysfunction in each. This study aimed to evaluate organ dysfunction using PELOD-۲ in critically ill children.Methods: This prospective observational study included all consecutive critically ill children with organ dysfunction aged one month to ۱۵ years admitted to pediatric intensive care unit of a Ramaiah Medical College Hospital, Bangalore between January ۲۰۱۸ and December ۲۰۲۰. The severity of organ dysfunction was scored using Pediatric logistic organ dysfunction-۲ (PELOD-۲) and evaluated based on the outcome using SPSS and PASW statistics for Windows version ۱۸.۰. The sample size required for the study with ۹۵% confidence level and ۱۰% relative precision was ۱۴۹ critically ill children. The children were classified based on the presence of single and multiple organ dysfunction. Demographics and laboratory parameters were compared between the two groups using non parametric tests. The factors affecting mortality among children with multiple organ dysfunction were assessed using univariate and multivariate analysis.Results: Of the ۵۵۰ children admitted with critical illness during the study period, organ dysfunction was present in ۸۴% of the patients. Of these, ۴۳% had multiple-organ dysfunction. The median (interquartile range) of the patients was ۵.۵ (۱, ۱۱) years with a male-to-female ratio of ۱.۷:۱. The mortality rate was ۱۴.۴%. The PELOD-۲ score and mortality steadily increased with the number of organs involved. The presence of more than two organ dysfunctions had an odd ratio (OR) of ۴۵.۷ for mortality (۹۵% CI: ۱۸.۹–۱۱۰.۶, P value<۰.۰۰۱). The area under the receiver operating curve(ROC) for predicting mortality using the number of organs affected was ۰.۹۶ (۹۵% CI: ۰.۹۴–۰.۹۷, P value<۰.۰۰۱). Dysfunction in more than two organs had a sensitivity of ۹۲.۵% and a specificity of ۹۱% in predicting mortality. The presence of cardiovascular dysfunction and the need for ventilation were found to be independent predictors of mortality.Conclusion: The presence of more than two organ dysfunctions in PELOD-۲ increased the risk of mortality; the need for ventilation and the presence of cardiovascular dysfunction were independent predictors of mortality.

Keywords:

Critical illness , children , mortality