Morin et al reported two septic shock scores which can help to identify a pediatric patient with refractory septic shock. The authors are from the ESPNIC (European Society of Paediatric and Neonatal Intensive Care) Refractory Septic Shock Definition Taskforce.
Patient selection: pediatric patient with septic shock
Parameters:
(1) vasoactive-inotrope score (VIS) in micrograms per kilogram per minute
(2) arterial blood lactate in mmol/L
(3) signs of myocardial dysfunction (resuscitation-responsive cardiac arrest in the PICU; echocardiographic left ventricular ejection fraction less than 25%; cardiac index less than 2.2 liters per minute per square meter BSA
computed septic shock score = cSSS =
= (1.001 ^ (VIS)) + (1.1 ^ (arterial lactate)) + (18 if there is evidence of myocardial dysfunction)
bedside septic shock score = bSSS =
= SUM(points for the 3 parameters)
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Parameters
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Finding
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Points
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VIS
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<= 200 µg per kg per min
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0
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> 200
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1
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arterial lactate
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(<= 8 mmol/L) AND (increase after 6 hours of therapy < 1 mmol/L)
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0
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|
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(> 8 mmol/L) OR (increase >= 1 mmol/L after 6 hours of therapy)
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1
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myocardial dysfunction
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absent
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0
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present
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3
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Interpretation:
• minimum bedside septic shock score: 0
• maximum bedside septic shock score: 5
Performance:
• A bedside SSS >= 2 had a sensitivity of 84% and specificity of 93%, giving a Youden index of 77%. The negative predictive value was 98%. The area under the ROC curve was 0.92.
• A cSSS >= 3.5 had a sensitivity of 90% and specificity of 90%, giving a Youden index of 80%. The negative predictive value was 99%. The area under the ROC curve was 0.96.
