Evaluation of PELOD-2 Scoring System in Predicting Mortality in Sepsis and Septic Shock in the PICU

Introduction: Sepsis in pediatric patients is a critical condition characterized by life-threatening organ dysfunction due to a dysregulated host response to infection. Pediatric sepsis presents unique diagnostic and prognostic challenges compared to adult sepsis. To address these, several pediatric-specific scoring systems have been developed, including the Pediatric Sequential Organ Failure Assessment (p-SOFA), Pediatric Risk of Mortality Score (PRISM), and Pediatric Logistic Organ Dysfunction-2 (PELOD-2). These tools aim to quantify organ dysfunction, predict mortality risk, and guide clinical management.


Methods: • Prospective observational study.
• Pediatric Intensive Care Unit (PICU) at PGIMS, Rohtak.
• Participants: Fifty pediatric patients aged 1 month to 14 years diagnosed with sepsis or septic shock.
• Exclusion Criteria: Patients with pre-existing chronic organ dysfunction.
• Data Collection: The PELOD-2 score was calculated daily from admission until discharge or death. Organ systems assessed included respiratory, central nervous, renal, hematologic, cardiovascular system.
• Outcome Measures: Primary outcome was mortality. Secondary outcomes included severity of organ dysfunction and its association with age groups.


Results: • Demographics: Mean age of patients was 6.33 years.
• System Involvement: Most common system affected at admission was the respiratory system (7 cases), followed by the central nervous system (6 cases).
• Age-wise Mortality:
o Infants (0-1 year): Highest severity scores and mortality rate (50%).
o Adolescents: Mortality rate of 66.67%.
o Children (other age groups): Mortality rate of 31.25%.
• Score Performance: The area under the receiver operating characteristic curve (AUROC) for the PELOD-2 score was 0.85, indicating good predictive accuracy for mortality.
• Daily Scoring: The PELOD-2 score was applied daily, allowing dynamic assessment of organ dysfunction severity.


Conclusions: The Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score is a valuable tool for predicting mortality and assessing the severity of organ dysfunction in pediatric patients with sepsis and septic shock. Its significant association with patient outcomes supports its integration into routine clinical practice for improved risk assessment and management in the PICU setting.