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Performance of the PRISM I, PIM2, PELOD-2 and PRISM IV scoring systems in western China: a multicenter prospective study

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Abstract

Background

The aim of this study was to evaluate the performance of the four scoring tools in predicting mortality in pediatric intensive care units (PICUs) in western China.

Methods

This was a multicenter, prospective, cohort study conducted in six PICUs in western China. The performances of the scoring systems were evaluated based on both discrimination and calibration. Discrimination was assessed by calculating the area under the receiver operating characteristic curve (AUC) for each model. Calibration was measured across defined groups based on mortality risk using the Hosmer-Lemeshow goodness-of-fit test.

Results

A total of 2034 patients were included in this study, of whom 127 (6.2%) died. For the entire cohort, AUCs for Pediatric Risk of Mortality Score (PRISM) I, Pediatric Index of Mortality 2 (PIM2), Pediatric Logistic Organ Dysfunction Score-2 (PELOD-2) and PRISM IV were 0.88 [95% confidence interval (CI) 0.85–0.92], 0.84 (95% CI 0.80–0.88), 0.80 (95% CI 0.75–0.85), and 0.91 (95% CI 0.88–0.94), respectively. The Hosmer-Lemeshow goodness-of-fit Chi-square value was 12.71 (P = 0.12) for PRISM I, 4.70 (P = 0.79) for PIM2, 205.98 (P < 0.001) for PELOD-2, and 7.50 (P = 0.48) for PRISM IV [degree of freedom (df) = 8]. The standardized mortality ratios obtained with the PRISM I, PIM2, PELOD-2, and PRISM IV models were 0.87 (95% CI, 0.75–1.01), 0.97 (95% CI, 0.85–1.12), 1.74 (95% CI, 1.58–1.92), and 1.05 (95% CI, 0.92–1.21), respectively.

Conclusions

PRISM IV performed best and can be used as a prediction tool in PICUs in Western China. However, PRISM IV needs to be further validated in NICUs.

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Data availability

The datasets used for the analysis in the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank Xiao-Chu Zhong (Imperial College, London, England) for data collection, analysis and interpretation. We thank Yue Zhou (West China Hospital, Chengdu, China), Lu-Ping Wang (West China Hospital, Chengdu, China), Kai-Bo Sun (West China Hospital, Chengdu, China), and Lu-Lu Cao (Mianyang Central Hospital, Mianyang, China) for data collection. We also thank the staff at each PICU for patient enrollment and data collection.

Funding

This work was supported by the National Natural Science Foundation of China (Grant Numbers 81400862 and 81401606), the Key Project of the Science & Technology Program of Sichuan Province (Grant Number 2019YFS0322), the Science Foundation for The Excellent Youth Scholars of Sichuan University (grant number 2015SU04A15), and the 1·3·5 Project for Disciplines of Excellence, West China Hospital of Sichuan University (Grant Numbers 2019HXFH056, 2020HXFH048 and YJC21060).

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    Authors and Affiliations

    1. Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China

      Xue-Peng Zhang, Kai-Ying Yang, Tong Qiu, Jiang-Yuan Zhou & Yi Ji

    2. Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, China

      Xue-Peng Zhang, Yang Li, Can-Zheng Wei, Hua Yao, Geng Zhang & Si-Yuan Chen

    3. Department of Nephrology, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China

      Yun-Xia Feng

    4. Department of Pediatric Critical Care Medicine, West China Women’s and Children’s Hospital, Sichuan University, Chengdu, 610041, China

      Guo-Yan Lu

    5. Department of Pediatric Critical Care Medicine, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, 610041, China

      Xin-Yue Zhou & Yu-Hang Hu

    6. Department of Critical Care Medicine, People’s Hospital of Tibet Autonomous Region, Lhasa, 850000, China

      Xi-Ying Gui & Hong Wu

    7. Department of Anesthesiology, the Affiliated Hospital of Guizhou Medical University, Guiyang, 550001, China

      Wen-Qi Zhang

    8. Department of Critical Care Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China

      Xue-Peng Zhang

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    Contributions

    XPZ: conceptualization, investigation, formal analysis, writing–original draft, supervision. SYC: conceptualization, writing–review, funding acquisition, supervision. YJ: conceptualization, writing–review, funding acquisition, supervision. YXF: data curation, writing–original draft. YL, GYL, XYZ, XYG, WQZ: data curation. JYZ, HY, GZ, YHH, HW: investigation. CZW, KYY, TQ: formal analysis. All authors approved the final version of the manuscript. Xue-Peng Zhang and Yun-Xia Feng contributed to the work equaly.

    Corresponding authors

    Correspondence to Si-Yuan Chen or Yi Ji.

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    Ethical approval for the study was provided by the Ethics Committee of the West China Hospital of Sichuan University (NO. 2018–272).

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    Zhang, XP., Feng, YX., Li, Y. et al. Performance of the PRISM I, PIM2, PELOD-2 and PRISM IV scoring systems in western China: a multicenter prospective study. World J Pediatr 18, 818–824 (2022). https://doi.org/10.1007/s12519-022-00603-8

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