Refining mortality risk stratification in pediatric sepsis: the roles of PELOD-2, vasoactive-inotropic scores, and procalcitonin in a tertiary hospital in Eastern Indonesia

Background: Sepsis is a leading cause of mortality and morbidity in children. While the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score is a common predictor of mortality, it does not account for the use of inotropic drugs or sepsis markers, which are addressed by the vasoactive-inotropic score (VIS) and measurements of procalcitonin levels. Combining these components enables faster and more accurate predictions of mortality risks. Therefore, this study aimed to develop a new stratification model of mortality risks by integrating PELOD-2, VIS, and procalcitonin among children with septic shock. Methods: A single-center, three-year, retrospective cohort study was conducted in the pediatric intensive care unit of a tertiary hospital. Children aged 1 month to 18 years and diagnosed with septic shock between 2022 and 2024 received vasoactive and/or inotropic support within 24 hours of diagnosis. PELOD-2 scores and procalcitonin levels were recorded at diagnosis. The cutoff values for PELOD-2, VIS, and procalcitonin were determined using receiver operating characteristic curves. Multivariate analysis was used to generate a final equation and validated with the Hosmer-Lemeshow goodness-of-fit test. Results: A total of 101 children were included, with a mortality rate of 78.2%. The optimal cutoff values were a PELOD-2 score ≥8 (sensitivity, 88.6%; specificity, 72.7%), a VIS score ≥11.5 (sensitivity, 78.5%; specificity, 72.7%), and a procalcitonin level ≥5 ng/ml (sensitivity, 74.7%; specificity, 68.2%). Multivariate analysis revealed significant associations with outcomes: PELOD-2 (adjusted odds ratio [aOR], 12.75; P<0.001), VIS (aOR, 4.686; P=0.02), and procalcitonin (aOR, 4.245; P=0.029). The new mortality risk prediction model achieved a range of 12.8% to 97.39% and exhibited excellent discriminator power (area under the curve, 0.911). The Hosmer-Lemeshow test confirmed good calibration. Conclusions: The new scoring approach that refines stratification of mortality risks by incorporating PELOD-2, VIS, and procalcitonin is a more comprehensive predictor.