• Sidra Ishaque, Stephen Thomas Famularo, Ali Faisal Saleem, SiddiquiNaveed Ur RehmanNURDepartment of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan., Zaubina Kazi, Sadia Parkar, Aneeta Hotwani, Neal J Thomas, Jill Marie Thompson, Patrick Lahni, Brian Varisco, and Nadir Yehya.
• Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan.
• Pediatr Crit Care Me. 2023 Jul 1; 24 (7): 563573563-573.

ObjectivesMost biomarker studies of sepsis originate from high-income countries, whereas mortality risk is higher in low- and middle-income countries. The second version of the Pediatric Sepsis Biomarker Risk Model (PERSEVERE-II) has been validated in multiple North American PICUs for prognosis. Given differences in epidemiology, we assessed the performance of PERSEVERE-II in septic children from Pakistan, a low-middle income country. Due to uncertainty regarding how well PERSEVERE-II would perform, we also assessed the utility of other select biomarkers reflecting endotheliopathy, coagulopathy, and lung injury.DesignProspective cohort study.SettingPICU in Aga Khan University Hospital in Karachi, Pakistan.PatientsChildren (< 18 yr old) meeting pediatric modifications of adult Sepsis-3 criteria between November 2020 and February 2022 were eligible.InterventionsNone.Measurements And Main ResultsPlasma was collected within 24 hours of admission and biomarkers quantified. The area under the receiver operating characteristic curve for PERSEVERE-II to discriminate 28-day mortality was determined. Additional biomarkers were compared between survivors and nonsurvivors and between subjects with and without acute respiratory distress syndrome. In 86 subjects (20 nonsurvivors, 23%), PERSEVERE-II discriminated mortality (area under the receiver operating characteristic curve, 0.83; 95% CI, 0.72-0.94) and stratified the cohort into low-, medium-, and high-risk of mortality. Biomarkers reflecting endotheliopathy (angiopoietin 2, intracellular adhesion molecule 1) increased across worsening risk strata. Angiopoietin 2, soluble thrombomodulin, and plasminogen activator inhibitor 1 were higher in nonsurvivors, and soluble receptor for advanced glycation end-products and surfactant protein D were higher in children meeting acute respiratory distress syndrome criteria.ConclusionsPERSEVERE-II performs well in septic children from Aga Khan University Hospital, representing the first validation of PERSEVERE-II in a low-middle income country. Patients possessed a biomarker profile comparable to that of sepsis from high-income countries, suggesting that biomarker-based enrichment strategies may be effective in this setting.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

27 keywords...

hide…