title: Performance of the PEdiatric Logistic Organ Dysfunction-2 score in critically ill children requiring plasma transfusions.
abstract: BACKGROUND
  Organ dysfunction scores, based on physiological parameters, have been created to describe organ failure. In a general pediatric intensive care unit (PICU) population, the PEdiatric Logistic Organ Dysfunction-2 score (PELOD-2) score had both a good discrimination and calibration, allowing to describe the clinical outcome of critically ill children throughout their stay. This score is increasingly used in clinical trials in specific subpopulation. Our objective was to assess the performance of the PELOD-2 score in a subpopulation of critically ill children requiring plasma transfusions.
  
  
  METHODS
  This was an ancillary study of a prospective observational study on plasma transfusions over a 6-week period, in 101 PICUs in 21 countries. All critically ill children who received at least one plasma transfusion during the observation period were included. PELOD-2 scores were measured on days 1, 2, 5, 8, and 12 after plasma transfusion. Performance of the score was assessed by the determination of the discrimination (area under the ROC curve: AUC) and the calibration (Hosmer-Lemeshow test).
  
  
  RESULTS
  Four hundred and forty-three patients were enrolled in the study (median age and weight: 1 year and 9.1 kg, respectively). Observed mortality rate was 26.9 % (119/443). For PELOD-2 on day 1, the AUC was 0.76 (95 % CI 0.71-0.81) and the Hosmer-Lemeshow test was p = 0.76. The serial evaluation of the changes in the daily PELOD-2 scores from day 1 demonstrated a significant association with death, adjusted for the PELOD-2 score on day 1.
  
  
  CONCLUSIONS
  In a subpopulation of critically ill children requiring plasma transfusion, the PELOD-2 score has a lower but acceptable discrimination than in an entire population. This score should therefore be used cautiously in this specific subpopulation.
authors.affiliation: Pediatric Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland. oliver.karam@hcuge.ch.|Univ. Lille, EA 2694 - Santé Publique: épidémiologie et qualité des soins, 59000, Lille, France. oliver.karam@hcuge.ch.
authors.forename: Oliver
authors.identifier: http://orcid.org/0000-0001-6606-1736
authors.initials: O
authors.lastname: Karam
authors.affiliation: Univ. Lille, EA 2694 - Santé Publique: épidémiologie et qualité des soins, 59000, Lille, France.|Pediatric Intensive Care Unit, CHC Liège, Liège, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Demaret
authors.affiliation: Univ. Lille, EA 2694 - Santé Publique: épidémiologie et qualité des soins, 59000, Lille, France.|Department of Biostatistics, CHU Lille, 59000, Lille, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.affiliation: Pediatric Intensive Care Unit, Oxford University Hospitals, Oxford, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Shefler
authors.affiliation: Division of Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Spinella
authors.affiliation: NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Stanworth
authors.affiliation: Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada.
authors.forename: Marisa
authors.initials: M
authors.lastname: Tucci
authors.affiliation: Univ. Lille, EA 2694 - Santé Publique: épidémiologie et qualité des soins, 59000, Lille, France.|Pediatric Intensive Care Unit, CHU Lille, 59000, Lille, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Leteurtre
keywords: Children; Critical care; Multiple organ failure; Outcome; Plasma transfusion; Score