Objective: Multiple organ dysfunction syndrome is the main cause of death in adult ICUs and in PICUs. The PEdiatric Logistic Organ Dysfunction score developed in 1999 was primarily designed to describe the severity of organ dysfunction. This study was undertaken to update and improve the PEdiatric Logistic Organ Dysfunction score, using a larger and more recent dataset.
Design: Prospective multicenter cohort study.
Setting: Nine multidisciplinary, tertiary-care PICUs of university-affiliated hospitals in France and Belgium.
Patients: All consecutive children admitted to these PICUs (June 2006–October 2007).
Measurements and Main Results: We collected data on variables considered for the PEdiatric Logistic Organ Dysfunction-2 score during PICU stay up to eight time points: days 1, 2, 5, 8, 12, 16, and 18, plus PICU discharge. For each variable considered for the PEdiatric Logistic Organ Dysfunction-2 score, the most abnormal value observed during time points was collected. The outcome was vital status at PICU discharge. Identification of the best variable cutoffs was performed using bivariate analyses. The PEdiatric Logistic Organ Dysfunction-2 score was developed by multivariable logistic regressions and bootstrap process. We used areas under the receiver-operating characteristic curve to evaluate discrimination and Hosmer-Lemeshow goodness-of-fit tests to evaluate calibration. We enrolled 3,671 consecutive patients (median age, 15.5 mo; interquartile range, 2.2–70.7). Mortality rate was 6.0% (222 deaths). The PEdiatric Logistic Organ Dysfunction-2 score includes ten variables corresponding to five organ dysfunctions. Discrimination (areas under the receiver-operating characteristic curve = 0.934) and calibration (chi-square test for goodness-of-fit = 9.31, p = 0.317) of the PEdiatric Logistic Organ Dysfunction-2 score were good.
Conclusion: We developed and validated the PEdiatric Logistic Organ Dysfunction-2 score, which allows assessment of the severity of cases of multiple organ dysfunction syndrome in the PICU with a continuous scale. The PEdiatric Logistic Organ Dysfunction-2 score now includes mean arterial pressure and lactatemia in the cardiovascular dysfunction and does not include hepatic dysfunction. The score will be in the public domain, which means that it can be freely used in clinical trials.
1Pediatric Intensive Care Unit, Jeanne de Flandre University Hospital, Lille, France.
2UDSL, Univ Lille Nord de France, Lille, France.
3Department of Biostatistics, CHU Lille, Lille, France.
4Department of Epidemiology and Public Health, Calmette University Hospital, Lille, France.
5Pediatric Intensive Care Unit, Sainte-Justine Hospital, Université de Montréal, Montréal, Canada.
Authors belonging to Groupe VALIDscore of the GFRUP: D. Biarent (Bruxelles, Belgium), R. Cremer (Lille, France); S. Dauger (Robert Debré-Paris, France), M. Dobrzynski (Brest, France), G. Emériaud (Grenoble, France), S. Renolleau (Trousseau-Paris, France), M. Roque-Gineste (Toulouse, France), D. Stamm, N. Richard (Lyon, France), and I. Wroblewski (Besançon, France).
All authors contributed to the study design drafted by Dr. Leteurtre. Drs. Leteurtre, Grandbastien, and Leclerc contributed to the clinical implementation of the study and supervision of the patients. Dr. Duhamel and Mr. Salleron designed and did the statistical analysis and verified its accuracy. Dr. Leclerc obtained funding and supervised the study. Dr. Leteurtre, Dr. Duhamel, Ms. Salleron, Dr. Grandbastien, and Dr. Leclerc had full access to all data. All authors helped draft this report or critically revised the draft. All authors reviewed and approved the final version of the report and had final responsibility for the decision to submit for publication.
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Supported, in part, by grant from the French Ministry of Health.
The sponsors of the study and the funding source had no role in the study design, data collection, data analysis, data interpretation, writing of the manuscript, or in the decision to submit to publication.
The authors have disclosed that they do not have any potential conflicts of interest.
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