A risk score based on pediatric sequential organ failure assessment predicts 90-day mortality in children with Klebsiella pneumoniae bloodstream infection
Abstract Background: Klebsiella pneumoniae bloodstream infection (Kp-BSI) is a serious threat to pediatric patients. The objective of this study was to explore the risk factors for mortality, validate the prediction efficiency of pediatric sequential organ failure assessment (SOFA) and establish better specific early predictors. Methods: All children diagnosed with Kp-BSI were included in this retrospective cohort study from January 2009 to June 2019. Basic characteristics, symptoms and physical examinations, laboratory statistics, and SOFA at the onset of Kp-BSI were recorded. The Cox proportional hazard model and the receiver operating characteristic curves were used to assess the association of the variables with the 90-day mortality and their predictive values. The DeLong's test of receiver operating characteristic curves and integrated discrimination improvement index were calculated to investigate predictive improvement of the modified SOFA models. A predictive score was developed using multivariate logistic regression. Results: Of the 146 children enrolled, 33 (22.6%) died within 90 days. Hospitalization within the previous six months, intra-abdominal source of bloodstream infection, presence of organ failures, and blood biomarkers including the C-reactive protein, albumin, and lactate were identified as significant risk factors for the 90-day mortality. The area under the curve (AUC) of SOFA for predicting 90-day mortality was 0.80 (95% CI 0.71–0.89). We further found a better combined model when adding hospitalization within the previous six months and intra-abdominal source of bloodstream infection into the SOFA score (AUC = 0.89, 95% CI 0.82–0.96, sensitivity = 0.86, specificity = 0.84). According to this novel risk model, we defined three statistically different groups: low-risk, medium-risk and high-risk groups, with an observed 90-day mortality of 5.4%, 35.7%, and 72.0%, respectively. With the reference of the low-risk group, the medium-risk and high-risk groups had a higher mortality, with hazard ratios of 8.36 (95% CI 3.60–27.83) and 20.27 (95% CI 7.47–54.95), respectively. Conclusions: The modified SOFA model may better predict the 90-day mortality of Kp-BSI. Future perspective studies will be required to validate this novel scoring system in external cohorts.