Pub Date : 2024-06-08DOI: 10.21608/cupsj.2024.271106.1118
Ilham Youssry, Heba Zarea, Hanaa Rady, Dina K Khedr
: Background: Early diagnosis of sepsis and its severity is essential for timely management to improve patient survival. Aim of the work: define prognostic indicators of mortality in children presenting with sepsis. Materials and Methods: A prospective observational cohort study included 45 children with sepsis admitted to the Pediatric Intensive Care Unit (PICU), Children Hospital, Cairo university. Studied predictors included clinical assessment, modified Sequential Organ Failure assessment m (SOFA) score calculation, age-adjusted quick Sequential Organ Failure assessment (qSOFA), Pediatric Risk of Mortality (PRISM) score and lab investigations, including reticulocyte distribution width (RDW). Results: The age of enrolled children with sepsis ranged between 0.16 - 5 years (median= 1 year), 27 (60 %) of them were males. Of them, 14 (31%) patients died. The mortality among them was predicted by the mSOFA above the cutoff point of 12 had 92% sensitivity, 96% specificity, 92% positive predictive value (PPV), and 96% negative predictive value (NPV) with area under the curve (AUC): 0.97, 95 % confidence interval (CI) 0.93 to 1, the PRISM III score above the cutoff point of 15 had 92% sensitivity, 90 %specificity, 81 % PPV, and 96% NPV with AUC: 0.96, 95 % CI 0.9 to 1, and the RDW above the cutoff point of 21 had 92% sensitivity, 66% specificity, 56% PPV, and 95% NPV with AUC: 0.86, 95 % CI 0.754 to 0.973. The age-adjusted qSOFA failed to predict mortality. Combining the RDW with these scores improved the mortality prediction as the combined RDW to the mSOFA above the cutoff point of 34 showed 100% sensitivity, 90 %specificity, 82 % PPV, and 100% NPV with AUC: 0.97, 95 % CI 0.93 to 1 and the combined RDW to the PRISM III score above the cutoff point of 41 had 92% sensitivity, 96 % specificity, 92 %, PPV, and 96% NPV with AUC: 0.98, 95 % CI 0.96 to 1. Conclusion: RDW combined with mSOFA score above the cutoff point of 34 and PRISM III score above the cutoff point of 41 were sensitive and specific predictors of mortality among children with sepsis. They may be used as indicators for timely referral of children with sepsis from the emergency ward to the PICU.
{"title":"Improving Prediction of Severity of Sepsis in Children: A Single Center trial","authors":"Ilham Youssry, Heba Zarea, Hanaa Rady, Dina K Khedr","doi":"10.21608/cupsj.2024.271106.1118","DOIUrl":"https://doi.org/10.21608/cupsj.2024.271106.1118","url":null,"abstract":": Background: Early diagnosis of sepsis and its severity is essential for timely management to improve patient survival. Aim of the work: define prognostic indicators of mortality in children presenting with sepsis. Materials and Methods: A prospective observational cohort study included 45 children with sepsis admitted to the Pediatric Intensive Care Unit (PICU), Children Hospital, Cairo university. Studied predictors included clinical assessment, modified Sequential Organ Failure assessment m (SOFA) score calculation, age-adjusted quick Sequential Organ Failure assessment (qSOFA), Pediatric Risk of Mortality (PRISM) score and lab investigations, including reticulocyte distribution width (RDW). Results: The age of enrolled children with sepsis ranged between 0.16 - 5 years (median= 1 year), 27 (60 %) of them were males. Of them, 14 (31%) patients died. The mortality among them was predicted by the mSOFA above the cutoff point of 12 had 92% sensitivity, 96% specificity, 92% positive predictive value (PPV), and 96% negative predictive value (NPV) with area under the curve (AUC): 0.97, 95 % confidence interval (CI) 0.93 to 1, the PRISM III score above the cutoff point of 15 had 92% sensitivity, 90 %specificity, 81 % PPV, and 96% NPV with AUC: 0.96, 95 % CI 0.9 to 1, and the RDW above the cutoff point of 21 had 92% sensitivity, 66% specificity, 56% PPV, and 95% NPV with AUC: 0.86, 95 % CI 0.754 to 0.973. The age-adjusted qSOFA failed to predict mortality. Combining the RDW with these scores improved the mortality prediction as the combined RDW to the mSOFA above the cutoff point of 34 showed 100% sensitivity, 90 %specificity, 82 % PPV, and 100% NPV with AUC: 0.97, 95 % CI 0.93 to 1 and the combined RDW to the PRISM III score above the cutoff point of 41 had 92% sensitivity, 96 % specificity, 92 %, PPV, and 96% NPV with AUC: 0.98, 95 % CI 0.96 to 1. Conclusion: RDW combined with mSOFA score above the cutoff point of 34 and PRISM III score above the cutoff point of 41 were sensitive and specific predictors of mortality among children with sepsis. They may be used as indicators for timely referral of children with sepsis from the emergency ward to the PICU.","PeriodicalId":509862,"journal":{"name":"Pediatric Sciences Journal","volume":"155 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141368512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.21608/cupsj.2024.254621.1111
A. AbdelMassih, Fatma Al Zahraa Mostafa, Reem Ismail, Mohamed Abd El Raouf, Mohammed Mohammed Abd El Raouf, Ayman Badr, Noha Ali
: Background : Atrial switch operation, was introduced by Ake Senning in 1958 for patients with D-transposition of great arteries (D-TGA). The major disadvantage of the atrial switch procedure is right ventricle (RV) failure in up to 7% to 10% of patients per 10 years. Aims of the work: To detect subclinical RV failure in children with D-TGA after atrial switch repair using conventional and nonconventional echocardiography. Subjects and Methods: We studied 25 children with D-TGA who underwent atrial switch operation following in the Postoperative Cardiology Clinic at Cairo University Specialized Pediatric Hospital. They did not have symptoms of heart failure. They underwent conventional echocardiography, tissue Doppler and speckle tracking imaging including RV global longitudinal strain (RV GLS) to detect subclinical heart failure according to New York Heart Association (NYHA) classification. The results were compared to a matched control group. Results: Mean age ± standard deviation of the studied group was 6.8 ± 4.3 years while mean age at time of operation ranged 14.2 ± 12.7 months (p=0.001). Mean RV global longitudinal strain (GLS) of cases (-14.5± 1.5%) was significantly impaired compared to RV GLS of controls (-20.2 ± 1.4%) (p <0.001). Tricuspid annular plane systolic excursion (TAPSE) of cases (12.7 ± 3.1 mm) was lower than TAPSE of controls (15.5 ± 2.3 mm) (p= 0.001). While RV myocardial performance index (MPI) of cases (0.47 ± 0.10) was higher than RV MPI of controls (0.34 ± 0.03) (p <0.001). There was a negative correlation between age at the time of surgery and RV GLS (r = -0.435) (p = 0.030). Non-conventional echocardiographic parameters RV MPI and RV GLS detected subclinical heart failure among all studied cases post-atrial switch. Conclusions: Non-conventional echocardiographic parameters RV MPI and RV GLS had higher sensitivity for detection of RV dysfunction and timely diagnosis of subclinical heart failure in patients of D-TGA after Senning atrial switch operation that was not detected by conventional echocardiography. Level of Evidence of
{"title":"Timely Detection of Subclinical Heart Failure Among Children with D-Transposition of Great Arteries after Senning Operation: A Single Center Experience","authors":"A. AbdelMassih, Fatma Al Zahraa Mostafa, Reem Ismail, Mohamed Abd El Raouf, Mohammed Mohammed Abd El Raouf, Ayman Badr, Noha Ali","doi":"10.21608/cupsj.2024.254621.1111","DOIUrl":"https://doi.org/10.21608/cupsj.2024.254621.1111","url":null,"abstract":": Background : Atrial switch operation, was introduced by Ake Senning in 1958 for patients with D-transposition of great arteries (D-TGA). The major disadvantage of the atrial switch procedure is right ventricle (RV) failure in up to 7% to 10% of patients per 10 years. Aims of the work: To detect subclinical RV failure in children with D-TGA after atrial switch repair using conventional and nonconventional echocardiography. Subjects and Methods: We studied 25 children with D-TGA who underwent atrial switch operation following in the Postoperative Cardiology Clinic at Cairo University Specialized Pediatric Hospital. They did not have symptoms of heart failure. They underwent conventional echocardiography, tissue Doppler and speckle tracking imaging including RV global longitudinal strain (RV GLS) to detect subclinical heart failure according to New York Heart Association (NYHA) classification. The results were compared to a matched control group. Results: Mean age ± standard deviation of the studied group was 6.8 ± 4.3 years while mean age at time of operation ranged 14.2 ± 12.7 months (p=0.001). Mean RV global longitudinal strain (GLS) of cases (-14.5± 1.5%) was significantly impaired compared to RV GLS of controls (-20.2 ± 1.4%) (p <0.001). Tricuspid annular plane systolic excursion (TAPSE) of cases (12.7 ± 3.1 mm) was lower than TAPSE of controls (15.5 ± 2.3 mm) (p= 0.001). While RV myocardial performance index (MPI) of cases (0.47 ± 0.10) was higher than RV MPI of controls (0.34 ± 0.03) (p <0.001). There was a negative correlation between age at the time of surgery and RV GLS (r = -0.435) (p = 0.030). Non-conventional echocardiographic parameters RV MPI and RV GLS detected subclinical heart failure among all studied cases post-atrial switch. Conclusions: Non-conventional echocardiographic parameters RV MPI and RV GLS had higher sensitivity for detection of RV dysfunction and timely diagnosis of subclinical heart failure in patients of D-TGA after Senning atrial switch operation that was not detected by conventional echocardiography. Level of Evidence of","PeriodicalId":509862,"journal":{"name":"Pediatric Sciences Journal","volume":"20 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139457937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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