title: A new scoring system derived from base excess and platelet count at presentation predicts mortality in paediatric meningococcal sepsis.
abstract: BACKGROUND
  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.
authors.forename: Alexessander
authors.initials: A
authors.lastname: Couto-Alves
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Wright
authors.forename: Karnan
authors.initials: K
authors.lastname: Perumal
authors.forename: Alexander
authors.initials: A
authors.lastname: Binder
authors.forename: Enitan D
authors.initials: ED
authors.lastname: Carrol
authors.forename: Marieke
authors.initials: M
authors.lastname: Emonts
authors.forename: Ronald
authors.initials: R
authors.lastname: de Groot
authors.forename: Jan
authors.initials: J
authors.lastname: Hazelzet
authors.forename: Taco
authors.initials: T
authors.lastname: Kuijpers
authors.forename: Simon
authors.initials: S
authors.lastname: Nadel
authors.forename: Werner
authors.initials: W
authors.lastname: Zenz
authors.forename: Padmanabhan
authors.initials: P
authors.lastname: Ramnarayan
authors.forename: Michael
authors.initials: M
authors.lastname: Levin
authors.forename: Lachlan
authors.initials: L
authors.lastname: Coin
authors.forename: David P
authors.initials: DP
authors.lastname: Inwald
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008589:Meningococcal Infections / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D009026:Mortality / Q000639:trends; D010976:Platelet Count / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D012720:Severity of Illness Index