Measuring blood levels of five key biomarkers can quickly and accurately predict the risk of death in children with septic shock, according to a study led by researchers at Cincinnati Children’s and the University of Cincinnati.
The test – called PERSEVERE – should help physicians decide much faster whether severely ill children in intensive care and emergency care settings require aggressive treatment to prevent septic shock from causing potentially fatal organ damage.
The 17-center study was led by Hector Wong, MD, Director, Division of Critical Care Medicine at Cincinnati Children’s Hospital Medical Center, and Christopher Lindsell, PhD, Department of Emergency Medicine at the University of Cincinnati College of Medicine. Results were posted online Jan. 29 in PLOS ONE.
The study involved 182 children, ages 1 to 13, who were receiving intensive care. The children identified by the test as positive for high-risk sepsis had a 34 percent chance of not surviving, but those who tested negative had only a 3 percent chance of dying.
Children who survived after testing positive for high-risk sepsis had greater degrees of organ failure and longer hospital stays than those who tested negative. The treatments received for their sepsis probably helped those children survive, the study authors say.
“Understanding the risk of mortality at an early time point is fundamental for clinical practice and clinical research. Without this objective information, we have nothing concrete to help us guide decisions on which patients need the most aggressive treatment,” Wong said.
In addition to guiding treatment decisions, this new tool could be used to select candidates for clinical trials and to measure the quality of care.
“If a patient that is predicted not to do well survives, it is a marker that the treatment worked,” Wong says. “The ability to estimate outcome risk is absolutely critical to all of these objectives.”
PERSEVERE combines measurements of the five biomarkers with other information about the patient to estimate the probability of survival. The test had been validated in a previous study involving 355 patients, but researchers pursued the new study to verify the tool’s effectiveness in a wider range of children.
The co-inventors and the Cincinnati Children’s Hospital Research Foundation have submitted a provisional patent application for PERSEVERE. Future research plans include studying how well the tool works for predicting outcomes for adults in septic shock.