The temporal version of the pediatric sepsis biomarker risk model

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 & 5 others Sharon Banschbach, Eileen Beckman, Kelli Harmon, Patrick Lahni, Christopher J. Lindsell

Research output: Contribution to journalArticle

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Abstract

Background: PERSEVERE is a risk model for estimating mortality probability in pediatric septic shock, using five biomarkers measured within 24 hours of clinical presentation. Objective: Here, we derive and test a temporal version of PERSEVERE (tPERSEVERE) that considers biomarker values at the first and third day following presentation to estimate the probability of a "complicated course", defined as persistence of ≥ 2 organ failures at seven days after meeting criteria for septic shock, or death within 28 days. Methods: Biomarkers were measured in the derivation cohort (n = 225) using serum samples obtained during days 1 and 3 of septic shock. Classification and Regression Tree (CART) analysis was used to derive a model to estimate the risk of a complicated course. The derived model was validated in the test cohort (n = 74), and subsequently updated using the combined derivation and test cohorts. Results: A complicated course occurred in 23% of the derivation cohort subjects. The derived model had a sensitivity for a complicated course of 90% (95% CI 78-96), specificity was 70% (62-77), positive predictive value was 47% (37-58), and negative predictive value was 96% (91-99). The area under the receiver operating characteristic curve was 0.85 (0.79-0.90). Similar test characteristics were observed in the test cohort. The updated model had a sensitivity of 91% (81-96), a specificity of 70% (64-76), a positive predictive value of 47% (39-56), and a negative predictive value of 96% (92-99). Conclusions: tPERSEVERE reasonably estimates the probability of a complicated course in children with septic shock. tPERSEVERE could potentially serve as an adjunct to physiological assessments for monitoring how risk for poor outcomes changes during early interventions in pediatric septic shock.

Original languageEnglish (US)
Article numbere92121
JournalPloS one
Volume9
Issue number3
DOIs
StatePublished - Mar 13 2014

Fingerprint

septic shock
sepsis (infection)
Pediatrics
Biomarkers
Septic Shock
biomarkers
Sepsis
testing
risk estimate
Physiologic Monitoring
ROC Curve
Regression Analysis
death
Mortality
Monitoring
monitoring
Serum
sampling

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Wong, H. R., Weiss, S. L., Giuliano, J. S., Wainwright, M. S., Cvijanovich, N. Z., Thomas, N. J., ... Lindsell, C. J. (2014). The temporal version of the pediatric sepsis biomarker risk model. PloS one, 9(3), [e92121]. https://doi.org/10.1371/journal.pone.0092121
Wong, Hector R. ; Weiss, Scott L. ; Giuliano, John S. ; Wainwright, Mark S. ; Cvijanovich, Natalie Z. ; Thomas, Neal J. ; Allen, Geoffrey L. ; Anas, Nick ; Bigham, Michael T. ; Hall, Mark ; Freishtat, Robert J. ; Sen, Anita ; Meyer, Keith ; Checchia, Paul A. ; Shanley, Thomas P. ; Nowak, Jeffrey ; Quasney, Michael ; Chopra, Arun ; Fitzgerald, Julie C. ; Gedeit, Rainer ; Banschbach, Sharon ; Beckman, Eileen ; Harmon, Kelli ; Lahni, Patrick ; Lindsell, Christopher J. / The temporal version of the pediatric sepsis biomarker risk model. In: PloS one. 2014 ; Vol. 9, No. 3.
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title = "The temporal version of the pediatric sepsis biomarker risk model",
abstract = "Background: PERSEVERE is a risk model for estimating mortality probability in pediatric septic shock, using five biomarkers measured within 24 hours of clinical presentation. Objective: Here, we derive and test a temporal version of PERSEVERE (tPERSEVERE) that considers biomarker values at the first and third day following presentation to estimate the probability of a {"}complicated course{"}, defined as persistence of ≥ 2 organ failures at seven days after meeting criteria for septic shock, or death within 28 days. Methods: Biomarkers were measured in the derivation cohort (n = 225) using serum samples obtained during days 1 and 3 of septic shock. Classification and Regression Tree (CART) analysis was used to derive a model to estimate the risk of a complicated course. The derived model was validated in the test cohort (n = 74), and subsequently updated using the combined derivation and test cohorts. Results: A complicated course occurred in 23{\%} of the derivation cohort subjects. The derived model had a sensitivity for a complicated course of 90{\%} (95{\%} CI 78-96), specificity was 70{\%} (62-77), positive predictive value was 47{\%} (37-58), and negative predictive value was 96{\%} (91-99). The area under the receiver operating characteristic curve was 0.85 (0.79-0.90). Similar test characteristics were observed in the test cohort. The updated model had a sensitivity of 91{\%} (81-96), a specificity of 70{\%} (64-76), a positive predictive value of 47{\%} (39-56), and a negative predictive value of 96{\%} (92-99). Conclusions: tPERSEVERE reasonably estimates the probability of a complicated course in children with septic shock. tPERSEVERE could potentially serve as an adjunct to physiological assessments for monitoring how risk for poor outcomes changes during early interventions in pediatric septic shock.",
author = "Wong, {Hector R.} and Weiss, {Scott L.} and Giuliano, {John S.} and Wainwright, {Mark S.} and Cvijanovich, {Natalie Z.} and Thomas, {Neal J.} and Allen, {Geoffrey L.} and Nick Anas and Bigham, {Michael T.} and Mark Hall and Freishtat, {Robert J.} and Anita Sen and Keith Meyer and Checchia, {Paul A.} and Shanley, {Thomas P.} and Jeffrey Nowak and Michael Quasney and Arun Chopra and Fitzgerald, {Julie C.} and Rainer Gedeit and Sharon Banschbach and Eileen Beckman and Kelli Harmon and Patrick Lahni and Lindsell, {Christopher J.}",
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Wong, HR, Weiss, SL, Giuliano, JS, Wainwright, MS, Cvijanovich, NZ, Thomas, NJ, Allen, GL, Anas, N, Bigham, MT, Hall, M, Freishtat, RJ, Sen, A, Meyer, K, Checchia, PA, Shanley, TP, Nowak, J, Quasney, M, Chopra, A, Fitzgerald, JC, Gedeit, R, Banschbach, S, Beckman, E, Harmon, K, Lahni, P & Lindsell, CJ 2014, 'The temporal version of the pediatric sepsis biomarker risk model', PloS one, vol. 9, no. 3, e92121. https://doi.org/10.1371/journal.pone.0092121

The temporal version of the pediatric sepsis biomarker risk model. / Wong, Hector R.; Weiss, Scott L.; Giuliano, John S.; Wainwright, Mark S.; Cvijanovich, Natalie Z.; Thomas, Neal J.; Allen, Geoffrey L.; Anas, Nick; Bigham, Michael T.; Hall, Mark; Freishtat, Robert J.; Sen, Anita; Meyer, Keith; Checchia, Paul A.; Shanley, Thomas P.; Nowak, Jeffrey; Quasney, Michael; Chopra, Arun; Fitzgerald, Julie C.; Gedeit, Rainer; Banschbach, Sharon; Beckman, Eileen; Harmon, Kelli; Lahni, Patrick; Lindsell, Christopher J.

In: PloS one, Vol. 9, No. 3, e92121, 13.03.2014.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The temporal version of the pediatric sepsis biomarker risk model

AU - Wong, Hector R.

AU - Weiss, Scott L.

AU - Giuliano, John S.

AU - Wainwright, Mark S.

AU - Cvijanovich, Natalie Z.

AU - Thomas, Neal J.

AU - Allen, Geoffrey L.

AU - Anas, Nick

AU - Bigham, Michael T.

AU - Hall, Mark

AU - Freishtat, Robert J.

AU - Sen, Anita

AU - Meyer, Keith

AU - Checchia, Paul A.

AU - Shanley, Thomas P.

AU - Nowak, Jeffrey

AU - Quasney, Michael

AU - Chopra, Arun

AU - Fitzgerald, Julie C.

AU - Gedeit, Rainer

AU - Banschbach, Sharon

AU - Beckman, Eileen

AU - Harmon, Kelli

AU - Lahni, Patrick

AU - Lindsell, Christopher J.

PY - 2014/3/13

Y1 - 2014/3/13

N2 - Background: PERSEVERE is a risk model for estimating mortality probability in pediatric septic shock, using five biomarkers measured within 24 hours of clinical presentation. Objective: Here, we derive and test a temporal version of PERSEVERE (tPERSEVERE) that considers biomarker values at the first and third day following presentation to estimate the probability of a "complicated course", defined as persistence of ≥ 2 organ failures at seven days after meeting criteria for septic shock, or death within 28 days. Methods: Biomarkers were measured in the derivation cohort (n = 225) using serum samples obtained during days 1 and 3 of septic shock. Classification and Regression Tree (CART) analysis was used to derive a model to estimate the risk of a complicated course. The derived model was validated in the test cohort (n = 74), and subsequently updated using the combined derivation and test cohorts. Results: A complicated course occurred in 23% of the derivation cohort subjects. The derived model had a sensitivity for a complicated course of 90% (95% CI 78-96), specificity was 70% (62-77), positive predictive value was 47% (37-58), and negative predictive value was 96% (91-99). The area under the receiver operating characteristic curve was 0.85 (0.79-0.90). Similar test characteristics were observed in the test cohort. The updated model had a sensitivity of 91% (81-96), a specificity of 70% (64-76), a positive predictive value of 47% (39-56), and a negative predictive value of 96% (92-99). Conclusions: tPERSEVERE reasonably estimates the probability of a complicated course in children with septic shock. tPERSEVERE could potentially serve as an adjunct to physiological assessments for monitoring how risk for poor outcomes changes during early interventions in pediatric septic shock.

AB - Background: PERSEVERE is a risk model for estimating mortality probability in pediatric septic shock, using five biomarkers measured within 24 hours of clinical presentation. Objective: Here, we derive and test a temporal version of PERSEVERE (tPERSEVERE) that considers biomarker values at the first and third day following presentation to estimate the probability of a "complicated course", defined as persistence of ≥ 2 organ failures at seven days after meeting criteria for septic shock, or death within 28 days. Methods: Biomarkers were measured in the derivation cohort (n = 225) using serum samples obtained during days 1 and 3 of septic shock. Classification and Regression Tree (CART) analysis was used to derive a model to estimate the risk of a complicated course. The derived model was validated in the test cohort (n = 74), and subsequently updated using the combined derivation and test cohorts. Results: A complicated course occurred in 23% of the derivation cohort subjects. The derived model had a sensitivity for a complicated course of 90% (95% CI 78-96), specificity was 70% (62-77), positive predictive value was 47% (37-58), and negative predictive value was 96% (91-99). The area under the receiver operating characteristic curve was 0.85 (0.79-0.90). Similar test characteristics were observed in the test cohort. The updated model had a sensitivity of 91% (81-96), a specificity of 70% (64-76), a positive predictive value of 47% (39-56), and a negative predictive value of 96% (92-99). Conclusions: tPERSEVERE reasonably estimates the probability of a complicated course in children with septic shock. tPERSEVERE could potentially serve as an adjunct to physiological assessments for monitoring how risk for poor outcomes changes during early interventions in pediatric septic shock.

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DO - 10.1371/journal.pone.0092121

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Wong HR, Weiss SL, Giuliano JS, Wainwright MS, Cvijanovich NZ, Thomas NJ et al. The temporal version of the pediatric sepsis biomarker risk model. PloS one. 2014 Mar 13;9(3). e92121. https://doi.org/10.1371/journal.pone.0092121