Nguyen Phat Nguyen

Context: Early discrimination of septic shock in children with sepsis remains challenging, and the comparative value of routinely available pretreatment biomarkers is uncertain. This study aimed to compare admission white blood cell count, C-reactive protein, procalcitonin (PCT, modeled as ln(PCT)), and lactate for early discrimination of septic shock in children with sepsis. Evidence Acquisition: We retrospectively studied children aged 2 months to 15 years who were admitted to a tertiary referral pediatric intensive care unit between July 2022 and July 2025. Biomarkers were defined as the earliest pretreatment measurements obtained at admission or within 6 hours. Early septic shock was operationally defined as the initiation of continuous vasoactive/inotropic support for sepsis-associated cardiovascular dysfunction within 24 hours. Discrimination was assessed using receiver operating characteristic analysis, and associations were examined using multivariable logistic regression. Results: Among 193 children, 93 (48.2%) met the operational definition of early shock. Lactate and PCT levels were higher in the early-shock group (both P < 0.001), whereas WBC and CRP levels were not. Lactate had the highest observed area under the receiver operating characteristic curve, at 0.77 (95% confidence interval [CI], 0.70 - 0.85), followed by PCT (0.71; 95% CI, 0.63 - 0.79). At the exploratory cohort-derived lactate cutoff of 4.17 mmol/L, sensitivity was 64.4% and specificity was 80.0%. In the complete-biomarker cohort, lactate was not statistically superior to PCT by paired DeLong testing (0.782 vs. 0.708; P = 0.197). In the primary parsimonious multivariable model, lactate (odds ratio [OR], 1.34 per 1-mmol/L increase; 95% CI, 1.14 - 1.58; P < 0.001) and natural logarithm-transformed PCT (OR, 1.25; 95% CI, 1.04 - 1.50; P = 0.019) were associated with early shock. In the expanded exploratory model, lactate remained associated (OR, 1.41; 95% CI, 1.17 - 1.70; P < 0.001), whereas the association with ln(PCT) was attenuated (P = 0.057). Conclusions: Admission lactate demonstrated the highest observed discrimination and may complement early clinical and hemodynamic assessments. The cohort-derived thresholds are exploratory and require external validation.

Background: Pediatric sepsis remains a critical global health concern due to its high morbidity and mortality. Several clinical scoring systems have been employed to assess disease severity and predict outcomes in patients with sepsis. The Phoenix Sepsis Score is a recently proposed pediatric-specific tool for risk stratification, but evidence on its performance in Southeast Asia remains limited. Objective: To evaluate clinical outcomes and assess the prognostic performance of the Phoenix Sepsis Score in predicting mortality among pediatric patients with sepsis. Materials and Methods: A cross-sectional analytical study was conducted on 94 pediatric patients (aged 2 months to 16 years) with sepsis admitted to a tertiary referral hospital in the Mekong Delta, Vietnam. Clinical, laboratory, and scoring variables were recorded within the first 6 hours after the diagnosis of sepsis. Prognostic performance was assessed using receiver operating characteristic curve analysis. Results: Among 94 patients, 67% were under 5 years of age. Lower Glasgow Coma Scale scores (10.96 ± 3.61 vs. 14.19 ± 3.41; p<0.001) and higher rates of septic shock (61.5% vs. 20.6%; p<0.001) were observed among non-survivors compared with survivors. The use of vasoactive agents (96.2% vs. 26.5%; p<0.001), mechanical ventilation (92.3% vs. 38.2%; p<0.001), and ≥2 antibiotic modifications (80.8% vs. 55.9%; p=0.026) were also associated with mortality. The Phoenix Sepsis Score demonstrated high discriminative ability (area under the curve [AUC], 0.947; 95% confidence interval [CI], 0.90–0.99), similar to that of the pediatric Sequential Organ Failure Assessment (pSOFA) score (AUC, 0.943; 95% CI, 0.898–0.988). At optimal cutoffs of 3.5 and 8.5 points, respectively, the Phoenix Sepsis Score showed higher sensitivity (92.3% vs. 76.9%), whereas pSOFA showed higher specificity (91.2% vs. 83.8%). Conclusion: The Phoenix Sepsis Score demonstrated prognostic performance similar to that of pSOFA in this cohort, with higher sensitivity but lower specificity. These findings suggest that the Phoenix Sepsis Score may be useful as a supportive tool for early risk stratification in pediatric sepsis, particularly in resource-limited settings. Further multicenter studies are required to validate these findings.