title: The temporal version of the pediatric sepsis biomarker risk model.
abstract: BACKGROUND
  PERSEVERE is a risk model for estimating mortality probability in pediatric septic shock, using five biomarkers measured within 24 hours of clinical presentation.
  
  
  OBJECTIVE
  Here, we derive and test a temporal version of PERSEVERE (tPERSEVERE) that considers biomarker values at the first and third day following presentation to estimate the probability of a "complicated course", defined as persistence of ≥2 organ failures at seven days after meeting criteria for septic shock, or death within 28 days.
  
  
  METHODS
  Biomarkers were measured in the derivation cohort (n = 225) using serum samples obtained during days 1 and 3 of septic shock. Classification and Regression Tree (CART) analysis was used to derive a model to estimate the risk of a complicated course. The derived model was validated in the test cohort (n = 74), and subsequently updated using the combined derivation and test cohorts.
  
  
  RESULTS
  A complicated course occurred in 23% of the derivation cohort subjects. The derived model had a sensitivity for a complicated course of 90% (95% CI 78-96), specificity was 70% (62-77), positive predictive value was 47% (37-58), and negative predictive value was 96% (91-99). The area under the receiver operating characteristic curve was 0.85 (0.79-0.90). Similar test characteristics were observed in the test cohort. The updated model had a sensitivity of 91% (81-96), a specificity of 70% (64-76), a positive predictive value of 47% (39-56), and a negative predictive value of 96% (92-99).
  
  
  CONCLUSIONS
  tPERSEVERE reasonably estimates the probability of a complicated course in children with septic shock. tPERSEVERE could potentially serve as an adjunct to physiological assessments for monitoring how risk for poor outcomes changes during early interventions in pediatric septic shock.
authors.affiliation: Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, Ohio, United States of America; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America.
authors.forename: Hector R
authors.initials: HR
authors.lastname: Wong
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Weiss
authors.affiliation: Division of Critical Care Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States of America.
authors.forename: John S
authors.initials: JS
authors.lastname: Giuliano
authors.affiliation: Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States of America.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Wainwright
authors.affiliation: Children's Hospital and Research Center Oakland, Oakland, California, United States of America.
authors.forename: Natalie Z
authors.initials: NZ
authors.lastname: Cvijanovich
authors.affiliation: Penn State Hershey Children's Hospital, Hershey, Pennsylvania, United States of America.
authors.forename: Neal J
authors.initials: NJ
authors.lastname: Thomas
authors.affiliation: Children's Mercy Hospital, Kansas City, Missouri, United States of America.
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Allen
authors.affiliation: Children's Hospital of Orange County, Orange, California, United States of America.
authors.forename: Nick
authors.initials: N
authors.lastname: Anas
authors.affiliation: Akron Children's Hospital, Akron, Ohio, United States of America.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Bigham
authors.affiliation: Nationwide Children's Hospital, Columbus, Ohio, United States of America.
authors.forename: Mark
authors.initials: M
authors.lastname: Hall
authors.affiliation: Children's National Medical Center, Washington, DC, United States of America.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Freishtat
authors.affiliation: Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, United States of America.
authors.forename: Anita
authors.initials: A
authors.lastname: Sen
authors.affiliation: Miami Children's Hospital, Miami, Florida, United States of America.
authors.forename: Keith
authors.initials: K
authors.lastname: Meyer
authors.affiliation: Texas Children's Hospital, Houston, Texas, United States of America.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Checchia
authors.affiliation: CS Mott Children's Hospital at the University of Michigan, Ann Arbor, Michigan, United States of America.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Shanley
authors.affiliation: Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota, United States of America.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Nowak
authors.affiliation: CS Mott Children's Hospital at the University of Michigan, Ann Arbor, Michigan, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Quasney
authors.affiliation: St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States of America.
authors.forename: Arun
authors.initials: A
authors.lastname: Chopra
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Fitzgerald
authors.affiliation: Children's Hospital of Wisconsin, Milwaukee, Wisconsin, United States of America.
authors.forename: Rainer
authors.initials: R
authors.lastname: Gedeit
authors.affiliation: Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, Ohio, United States of America.
authors.forename: Sharon
authors.initials: S
authors.lastname: Banschbach
authors.affiliation: Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, Ohio, United States of America.
authors.forename: Eileen
authors.initials: E
authors.lastname: Beckman
authors.affiliation: Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, Ohio, United States of America.
authors.forename: Kelli
authors.initials: K
authors.lastname: Harmon
authors.affiliation: Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, Ohio, United States of America.
authors.forename: Patrick
authors.initials: P
authors.lastname: Lahni
authors.affiliation: Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
mesh_terms: D015415:Biomarkers / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D005260:Female; D018869:Heat-Shock Response; D006801:Humans; D007223:Infant; D008297:Male; D008962:Models, Theoretical; D009026:Mortality; D010372:Pediatrics; D011379:Prognosis; D018570:Risk Assessment; D012772:Shock, Septic / Q000097:blood* / Q000401:mortality / Q000473:pathology
chemical_list: D015415:Biomarkers