Clinical prognostic models in children with sepsis in low- and middle-income countries: a systematic review and meta-analysis.

IF 2.1 3区医学 Q2 PEDIATRICS Frontiers in Pediatrics Pub Date : 2024-10-17 eCollection Date: 2024-01-01 DOI:10.3389/fped.2024.1463986

Jessica Jordan, Celinie M Nguyen, Lauren M Fletcher, Stephanie C Garbern

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Abstract

Introduction: Sepsis is the leading cause of child death worldwide, with the majority of these deaths occurring in low- and middle-income countries (LMICs). The aim of this systematic review and meta-analysis was to describe clinical prognostic scores and models for pediatric sepsis outcomes and assess the performance of these scores for predicting mortality in LMICs.

Methods: Ovid Medline, CINAHL, Cochrane Library, EBSCO Global Health, and Web of Science, were searched through September 2022 for citations related to the development or validation of a clinical prognostic score or model among children with sepsis, conducted in LMIC. Titles, abstracts, and full texts were screened by two independent reviewers and data extracted included population characteristics, variables included, outcomes, and model performance. Risk of bias was assessed with the Prediction Model Risk of Bias Assessment Tool (PROBAST).

Results: 4,251 titles/abstracts and 315 full-text studies were screened, with 12 studies meeting inclusion criteria. Study countries included India, China, Egypt, Indonesia, Tanzania, and a multi-site study in Latin America. Prognostic scores/models included existing scores such as PELOD-2, pSOFA, PRISM, P-MODS, refractory shock criteria. There was high risk of bias in all studies. Meta-analysis was possible for pSOFA, PELOD-2, PRISM, and P-MODS, with pooled area under the receiver-operator characteristic curve of 0.86 (95%CI 0.78-0.94), 0.83 (95% CI 0.76-0.91), respectively.

Conclusion: Relatively few clinical scores and models have been externally validated for prognostication and risk-stratification among children with sepsis in diverse LMIC settings. Notably there were no studies from low-income countries. Some potentially relevant studies were excluded due to lack of clarity regarding the presence of sepsis in the study populations. More widespread and standardized use of sepsis criteria may aid in better understanding the burden of sepsis and prognostic model performance at the bedside among children in LMICs. Further research to externally validate, implement and adapt these models is needed to account for challenges in use of these scores in resource-limited settings.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022340126, PROSPERO [CRD42022340126].

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中低收入国家儿童败血症临床预后模型：系统回顾和荟萃分析。

导言：败血症是全球儿童死亡的主要原因，其中大部分死亡病例发生在中低收入国家（LMICs）。本系统综述和荟萃分析旨在描述儿科脓毒症结果的临床预后评分和模型，并评估这些评分在预测中低收入国家死亡率方面的性能：方法：检索了 Ovid Medline、CINAHL、Cochrane Library、EBSCO Global Health 和 Web of Science 上截至 2022 年 9 月有关在 LMIC 地区开发或验证脓毒症患儿临床预后评分或模型的引文。标题、摘要和全文由两名独立审稿人进行筛选，提取的数据包括人群特征、包含的变量、结果和模型性能。采用预测模型偏倚风险评估工具（PROBAST）评估偏倚风险：筛选了 4,251 篇标题/摘要和 315 篇全文研究，其中 12 篇研究符合纳入标准。研究国家包括印度、中国、埃及、印度尼西亚、坦桑尼亚以及拉丁美洲的一项多站点研究。预后评分/模型包括现有评分，如 PELOD-2、pSOFA、PRISM、P-MODS、难治性休克标准。所有研究的偏倚风险都很高。pSOFA、PELOD-2、PRISM和P-MODS可进行荟萃分析，接收器-操作者特征曲线下的集合面积分别为0.86（95%CI 0.78-0.94）、0.83（95%CI 0.76-0.91）：在不同的低收入与中等收入国家环境中，经外部验证可用于脓毒症患儿预后和风险分级的临床评分和模型相对较少。值得注意的是，没有来自低收入国家的研究。一些潜在的相关研究因研究人群中是否存在败血症而被排除在外。脓毒症标准的更广泛和标准化使用有助于更好地了解脓毒症的负担以及预后模型在低收入和中等收入国家儿童床旁的表现。需要进一步开展研究，从外部验证、实施和调整这些模型，以应对在资源有限的环境中使用这些评分所面临的挑战。系统综述注册：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022340126，PROSPERO [CRD42022340126]。

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来源期刊

Frontiers in Pediatrics Medicine-Pediatrics, Perinatology and Child Health

CiteScore

3.60

自引率

7.70%

发文量

2132

审稿时长

14 weeks

期刊介绍： Frontiers in Pediatrics (Impact Factor 2.33) publishes rigorously peer-reviewed research broadly across the field, from basic to clinical research that meets ongoing challenges in pediatric patient care and child health. Field Chief Editors Arjan Te Pas at Leiden University and Michael L. Moritz at the Children''s Hospital of Pittsburgh are supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. Frontiers in Pediatrics also features Research Topics, Frontiers special theme-focused issues managed by Guest Associate Editors, addressing important areas in pediatrics. In this fashion, Frontiers serves as an outlet to publish the broadest aspects of pediatrics in both basic and clinical research, including high-quality reviews, case reports, editorials and commentaries related to all aspects of pediatrics.