title: Daily estimation of the severity of organ dysfunctions in critically ill children by using the PELOD-2 score.
abstract: BACKGROUND
  Daily or serial evaluation of multiple organ dysfunction syndrome (MODS) scores may provide useful information. We aimed to validate the daily (d) PELOD-2 score using the set of seven days proposed with the previous version of the score.
  
  
  METHODS
  In all consecutive patients admitted to nine pediatric intensive care units (PICUs) we prospectively measured the dPELOD-2 score at day 1, 2, 5, 8, 12, 16, and 18. PICU mortality was used as the outcome dependent variable. The discriminant power of the dPELOD-2 scores was estimated using the area under the ROC curve and the calibration using the Hosmer-Lemeshow chi-square test. We used a logistic regression to investigate the relationship between the dPELOD-2 scores and outcome, and between the change in PELOD-2 score from day 1 and outcome.
  
  
  RESULTS
  We included 3669 patients (median age 15.5 months, mortality rate 6.1%, median length of PICU stay 3 days). Median dPELOD-2 scores were significantly higher in nonsurvivors than in survivors (p < 0.0001). The dPELOD-2 score was available at least at day 2 in 2057 patients: among the 796 patients without MODS on day 1, 186 (23.3%) acquired the syndrome during their PICU stay (mortality 4.9% vs. 0.3% among the 610 who did not; p < 0.0001). Among the 1261 patients with MODS on day 1, the syndrome worsened in 157 (12.4%) and remained unchanged or improved in 1104 (87.6%) (mortality 22.9% vs. 6.6%; p < 0.0001). The AUC of the dPELOD-2 scores ranged from 0.75 (95% CI: 0.67-0.83) to 0.89 (95% CI: 0.86-0.91). The calibration was good with a chi-square test between 13.5 (p = 0.06) and 0.9 (p = 0.99). The PELOD-2 score on day 1 was a significant prognostic factor; the serial evaluation of the change in the dPELOD-2 score from day1, adjusted for baseline value, demonstrated a significant odds ratio of death for each of the 7 days.
  
  
  CONCLUSIONS
  This study suggests that the progression of the severity of organ dysfunctions can be evaluated by measuring the dPELOD-2 score during a set of 7 days in PICU, providing useful information on outcome in critically ill children. Its external validation would be useful.
authors.affiliation: Pediatric Intensive Care Unit, Jeanne de Flandre University Hospital, 2 avenue Eugène Avinée, 59037, Lille, Cedex, France. stephane.leteurtre@chru-lille.fr.|EA 2694, Public Health: Epidemiology and Quality of Care, University of Lille 2, Lille, France. stephane.leteurtre@chru-lille.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Leteurtre
authors.affiliation: EA 2694, Public Health: Epidemiology and Quality of Care, University of Lille 2, Lille, France. alain.duhamel@univ-lille2.fr.|Department of Biostatistics, University of Medicine, Lille, France. alain.duhamel@univ-lille2.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.affiliation: EA 2694, Public Health: Epidemiology and Quality of Care, University of Lille 2, Lille, France. vdeken.chr@gmail.com.|Department of Biostatistics, University of Medicine, Lille, France. vdeken.chr@gmail.com.
authors.forename: Valérie
authors.initials: V
authors.lastname: Deken
authors.affiliation: Pediatric Intensive Care Unit, Sainte-Justine Hospital, Université de Montréal, Montréal, Canada. jacques_lacroix@ssss.gouv.qc.ca.
authors.forename: Jacques
authors.initials: J
authors.lastname: Lacroix
authors.affiliation: Pediatric Intensive Care Unit, Jeanne de Flandre University Hospital, 2 avenue Eugène Avinée, 59037, Lille, Cedex, France. francis.leclerc@chru-lille.fr.|EA 2694, Public Health: Epidemiology and Quality of Care, University of Lille 2, Lille, France. francis.leclerc@chru-lille.fr.
authors.forename: Francis
authors.initials: F
authors.lastname: Leclerc
mesh_terms: D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000145:classification*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D008297:Male; D063305:Organ Dysfunction Scores; D011446:Prospective Studies; D012720:Severity of Illness Index