• Hector R Wong, Scott L Weiss, John S Giuliano, Mark S Wainwright, Natalie Z Cvijanovich, Neal J Thomas, Geoffrey L Allen, Nick Anas, Michael T Bigham, Mark Hall, Robert J Freishtat, Anita Sen, Keith Meyer, Paul A Checchia, Thomas P Shanley, Jeffrey Nowak, Michael Quasney, Arun Chopra, Julie C Fitzgerald, Rainer Gedeit, Sharon Banschbach, Eileen Beckman, Patrick Lahni, Kimberly Hart, and Christopher J Lindsell.
• 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.
• Plos One. 2014 Jan 1;9(1):e86242.

BackgroundWe previously derived and validated a risk model to estimate mortality probability in children with septic shock (PERSEVERE; PEdiatRic SEpsis biomarkEr Risk modEl). PERSEVERE uses five biomarkers and age to estimate mortality probability. After the initial derivation and validation of PERSEVERE, we combined the derivation and validation cohorts (n = 355) and updated PERSEVERE. An important step in the development of updated risk models is to test their accuracy using an independent test cohort.ObjectiveTo test the prognostic accuracy of the updated version PERSEVERE in an independent test cohort.MethodsStudy subjects were recruited from multiple pediatric intensive care units in the United States. Biomarkers were measured in 182 pediatric subjects with septic shock using serum samples obtained during the first 24 hours of presentation. The accuracy of PERSEVERE 28-day mortality risk estimate was tested using diagnostic test statistics, and the net reclassification improvement (NRI) was used to test whether PERSEVERE adds information to a physiology-based scoring system.ResultsMortality in the test cohort was 13.2%. Using a risk cut-off of 2.5%, the sensitivity of PERSEVERE for mortality was 83% (95% CI 62-95), specificity was 75% (68-82), positive predictive value was 34% (22-47), and negative predictive value was 97% (91-99). The area under the receiver operating characteristic curve was 0.81 (0.70-0.92). The false positive subjects had a greater degree of organ failure burden and longer intensive care unit length of stay, compared to the true negative subjects. When adding PERSEVERE to a physiology-based scoring system, the net reclassification improvement was 0.91 (0.47-1.35; p<0.001).ConclusionsThe updated version of PERSEVERE estimates mortality probability reliably in a heterogeneous test cohort of children with septic shock and provides information over and above a physiology-based scoring system.

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