Open Access Highly Accessed Research

A new scoring system derived from base excess and platelet count at presentation predicts mortality in paediatric meningococcal sepsis

Alexessander Couto-Alves1, Victoria J Wright2, Karnan Perumal3, Alexander Binder4, Enitan D Carrol5, Marieke Emonts6, Ronald de Groot7, Jan Hazelzet8, Taco Kuijpers9, Simon Nadel2, Werner Zenz4, Padmanabhan Ramnarayan10, Michael Levin2, Lachlan Coin1 and David P Inwald2*

Author Affiliations

1 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, Norfolk Place, London W2 1PG, UK

2 Department of Paediatrics, Imperial College, Norfolk Place, London W2 1PG, UK

3 Paediatric Intensive Care Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK

4 Department of General Paediatrics, Medical University of Graz, Auenbruggerplatz 30, A-8036 Graz, Austria

5 Institute of Child Health, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK

6 Department of Paediatrics, Division of Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, Dr Molewaterplein 60, 3015 GJ, Rotterdam, Netherlands

7 Radboud University Nijmegen Medical Centre, Geert Grooteplein 8, Route 463, 6500 HB Nijmegen, Netherlands

8 Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, Dr Molewaterplein 60, 3015 GJ, Rotterdam, Netherlands

9 Department of Paediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands

10 Children's Acute Transport Service, PO Box 36829, London WC1N 3WH, UK

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Critical Care 2013, 17:R68  doi:10.1186/cc12609

Published: 11 April 2013

Abstract

Introduction

The aim of this study was to derive a novel prognostic score for mortality in paediatric meningococcal sepsis (MS) based on readily available laboratory markers.

Methods

A multicentre retrospective cohort study for the consortium set and a single centre retrospective study for replication set. The consortium set were 1,073 children (age 1 week to 17.9 years) referred over a 15-year period (1996 to 2011), who had an admission diagnosis of MS, referred to paediatric intensive care units (PICUs) in six different European centres. The consortium set was split into a development set and validation set to derive the score. The replication set were 134 children with MS (age 2 weeks to 16 years) referred over a 4-year period (2007 to 2011) to PICUs via the Children's Acute Transport Service (CATS), London.

Results

A total of 85/1,073 (7.9%) children in the consortium set died. A total of 16/134 (11.9%) children in the replication set died. Children dying in the consortium set had significantly lower base excess, C-reactive protein (CRP), platelet and white cell count, more deranged coagulation and higher lactate than survivors. Paediatric risk of mortality (PRISM) score, Glasgow meningococcal septicaemia prognosis score (GMSPS) and Rotterdam score were also higher. Using the consortium set, a new scoring system using base excess and platelet count at presentation, termed the BEP score, was mathematically developed and validated. BEP predicted mortality with high sensitivity and specificity scores (area under the curve (AUC) in the validation set = 0.86 and in the replication set = 0.96). In the validation set, BEP score performance (AUC = 0.86, confidence interval (CI): 0.80 to 0.91) was better than GMSPS (AUC = 0.77, CI: 0.68, 0.85), similar to Rotterdam (AUC = 0.87, CI: 0.81 to 0.93) and not as good as PRISM (AUC = 0.93, CI: 0.85 to 0.97).

Conclusions

The BEP score, relying on only two variables that are quickly and objectively measurable and readily available at presentation, is highly sensitive and specific in predicting death from MS in childhood.