Mortality Predictive Scores for Community-Acquired Pneumonia in Children

Diagnostic and predictive value of Respiratory Index of Severity in Children (RISC) scoring system in community-acquired pneumonia: a prospective cross sectional study

Background

Community-acquired pneumonia (CAP) exhibits high mortality rates among children, accounting for up to 50% in severe cases.

Respiratory Index of Severity in Children (RISC) score is a six-predictor standardized means for assessment of the severity of respiratory illness among children. The aim of this study was to validate the RISC score in evaluation of mortality outcome in hospitalized infants diagnosed with CAP.

Methods

This prospective cross-sectional study was conducted on 150 Egyptian children who were diagnosed to have CAP, admitted to the general wards and pediatric intensive care units (PICUs) of Cairo University Children Hospital, Faculty of Medicine, Cairo University from September 2019 to June 2020.

Results

Median RISC score was significantly higher in non-survivors compared with survivors (p < 0.001). There were significant direct correlations between RISC score and each of respiratory distress grade, C-reactive protein (CRP), PICU admission, mechanical ventilation (MV) and mortality (p < 0.05). The RISC score, assessed within 24 h of admission, had sensitivity of 85.71%, and specificity 89.51% in discriminating infants with CAP who survived from those who died (determined at a cut off > 3). The RISC score was a significant predictor for mortality in infants with CAP (Odds ratio = 5.17, p < 0.001).

Conclusion

The RISC score helps in prediction of mortality among children with CAP. Future studies are needed to validate RISC score as a guide for effective management protocol.

External validation of the RISC, RISC-Malawi, and PERCH clinical prediction rules to identify risk of death in children hospitalized with pneumonia

BACKGROUND

Existing scores to identify children at risk of hospitalized pneumonia-related mortality lack broad external validation. Our objective was to externally validate three such risk scores.

METHODS

We applied the Respiratory Index of Severity in Children (RISC) for HIV-negative children, the RISC-Malawi, and the Pneumonia Etiology Research for Child Health (PERCH) scores to hospitalized children in the Pneumonia REsearch Partnerships to Assess WHO REcommendations (PREPARE) data set. The PREPARE data set includes pooled data from 41 studies on pediatric pneumonia from across the world. We calculated test characteristics and the area under the curve (AUC) for each of these clinical prediction rules.

RESULTS

The RISC score for HIV-negative children was applied to 3574 children 0-24 months and demonstrated poor discriminatory ability (AUC = 0.66, 95% confidence interval (CI) = 0.58-0.73) in the identification of children at risk of hospitalized pneumonia-related mortality. The RISC-Malawi score had fair discriminatory value (AUC = 0.75, 95% CI = 0.74-0.77) among 17 864 children 2-59 months. The PERCH score was applied to 732 children 1-59 months and also demonstrated poor discriminatory value (AUC = 0.55, 95% CI = 0.37-0.73).

CONCLUSIONS

In a large external application of the RISC, RISC-Malawi, and PERCH scores, a substantial number of children were misclassified for their risk of hospitalized pneumonia-related mortality. Although pneumonia risk scores have performed well among the cohorts in which they were derived, their performance diminished when externally applied. A generalizable risk assessment tool with higher sensitivity and specificity to identify children at risk of hospitalized pneumonia-related mortality may be needed. Such a generalizable risk assessment tool would need context-specific validation prior to implementation in that setting.

Modified PIRO (predisposition, insult, response, organ dysfunction) severity score as a predictor for mortality of children with pneumonia in Hasan Sadikin Hospital, Bandung, Indonesia

Background

Clinical manifestations for pneumonia vary from mild to severe. The PIRO model (predisposition, insult, response, organ dysfunction) was used as scoring system to determine severity of sepsis and pneumonia in adult patients. The PIRO model was modified for sorting the severity of pneumonia in children and predicting its risk of mortality.

Methods

An ambispective cohort study of pneumonia patients aged 1 month to ≤ 18 years admitted over the period from May to September 2020. Data were collected from history, physical examination, laboratory examination, and chest radiography. Based on bivariate analysis (p<0.05 and relative risk (RR) with 95% confidence interval), variables of each PIRO component that were significant for mortality were assigned a value of 1. The cut-off score for predictor of mortality was calculated using the receiver operating characteristics (ROC) curve and the scores were stratified into three degrees of risk based on interquartile range, score ≤Q1 was categorized as low risk; Q1-Q3 was categorized as moderate risk; and score >Q3 was categorized as high risk.

Results

Out of the 80 subjects enrolled, 6 months-5 years was the largest age group (56.3%). The observed mortality was 15/80 (18.8%). The modified PIRO severity score was compiled from significant variables of predisposition (malnutrition), insult (chest radiograph), response (hypoxemia, hypotension, CRP >0.5 mg/dL, PCT >0.5 ng/dL) and organ dysfunction, with range of score 0-7. Score >3 was categorized as a cut-off point score for predictor of mortality with AUC 0.919 (95% CI 0.836–0.968), sensitivity of 80%, and specificity of 84.62%. Subjects with score >3 have RR of 10.544 compared to those with score ≤3. The stratification of score level was low (≤2), moderate (3-4), and high (5-7). The mortality levels were 0%, 46.7%, and 53.3%, respectively.

Conclusions

Modified PIRO severity score can be used as a sorting tool and predictor of mortality risk in children with pneumonia. This score can also be used to select candidates for intensive care, especially in health facilities with limited intensive care capacity.

Exploring calixarene-based clusters for efficient functional presentation of Streptococcus pneumoniae saccharides

Calixarenes are promising scaffolds for an efficient clustered exposition of multiple saccharide antigenic units. Herein we report the synthesis and biological evaluation of a calix[6]arene functionalized with six copies of the trisaccharide repeating unit of Streptococcus pneumoniae (SP) serotype 19F. This system has demonstrated its ability to efficiently inhibit the binding between the native 19F capsular polysaccharide and anti-19F antibodies, despite a low number of exposed saccharide antigens, well mimicking the epitope presentations in the polysaccharide. The calix[6]arene mobile scaffold has been selected for functionalization with SP 19F repeating unit after a preliminary screening of four model glycocalixarenes, functionalized with N-acetyl mannosamine, and differing in the valency and/or conformational properties. This work is a step forward towards the development of new fully synthetic calixarenes comprising small carbohydrate antigens as potential carbohydrate-based vaccine scaffolds.