A new scoring system derived from base excess and platelet count at presentation predicts mortality in paediatric meningococcal sepsis

Couto-Alves, Alexessander, Wright, Victoria J., Perumal, Karnan, Binder, Alexander, Carrol, Enitan D., Emonts, Marieke, de Groot, Ronald, Hazelzet, Jan, Kuijpers, Taco, Nadel, Simon, Zenz, Werner, Ramnarayan, Padmanabhan, Levin, Michael, Coin, Lachlan and Inwald, David P. (2013) A new scoring system derived from base excess and platelet count at presentation predicts mortality in paediatric meningococcal sepsis. Critical Care, 17 2: . doi:10.1186/cc12609


Author Couto-Alves, Alexessander
Wright, Victoria J.
Perumal, Karnan
Binder, Alexander
Carrol, Enitan D.
Emonts, Marieke
de Groot, Ronald
Hazelzet, Jan
Kuijpers, Taco
Nadel, Simon
Zenz, Werner
Ramnarayan, Padmanabhan
Levin, Michael
Coin, Lachlan
Inwald, David P.
Title A new scoring system derived from base excess and platelet count at presentation predicts mortality in paediatric meningococcal sepsis
Journal name Critical Care   Check publisher's open access policy
ISSN 1364-8535
1466-609X
Publication date 2013-04-01
Year available 2013
Sub-type Article (original research)
DOI 10.1186/cc12609
Open Access Status DOI
Volume 17
Issue 2
Total pages 11
Place of publication Philadelphia, United States
Publisher Current Science
Language eng
Subject 2706 Critical Care and Intensive Care Medicine
Formatted abstract
Introduction: The aim of this study was to derive a novel prognostic score for mortality in paediatric meningococcal sepsis (MS) based on readily available laboratory markers.
Methods: A multicentre retrospective cohort study for the consortium set and a single centre retrospective study for replication set. The consortium set were 1,073 children (age 1 week to 17.9 years) referred over a 15-year period (1996 to 2011), who had an admission diagnosis of MS, referred to paediatric intensive care units (PICUs) in six different European centres. The consortium set was split into a development set and validation set to derive the score. The replication set were 134 children with MS (age 2 weeks to 16 years) referred over a 4-year period (2007 to 2011) to PICUs via the Children's Acute Transport Service (CATS), London.
Results: A total of 85/1,073 (7.9%) children in the consortium set died. A total of 16/134 (11.9%) children in the replication set died. Children dying in the consortium set had significantly lower base excess, C-reactive protein (CRP), platelet and white cell count, more deranged coagulation and higher lactate than survivors. Paediatric risk of mortality (PRISM) score, Glasgow meningococcal septicaemia prognosis score (GMSPS) and Rotterdam score were also higher. Using the consortium set, a new scoring system using base excess and platelet count at presentation, termed the BEP score, was mathematically developed and validated. BEP predicted mortality with high sensitivity and specificity scores (area under the curve (AUC) in the validation set = 0.86 and in the replication set = 0.96). In the validation set, BEP score performance (AUC = 0.86, confidence interval (CI): 0.80 to 0.91) was better than GMSPS (AUC = 0.77, CI: 0.68, 0.85), similar to Rotterdam (AUC = 0.87, CI: 0.81 to 0.93) and not as good as PRISM (AUC = 0.93, CI: 0.85 to 0.97).
Conclusions: The BEP score, relying on only two variables that are quickly and objectively measurable and readily available at presentation, is highly sensitive and specific in predicting death from MS in childhood.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
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