LAUSR

Initial correspondence from Drs. Leclerc, Duhamel, Leteurtre Dear Editor, We read with interest the paper by Schlapbach et al. comparing the performance of SIRS criteria with measures of organ dysfunction in children with sepsis [1]. The performance of pediatric SOFA (pSOFA) at discriminating mortality was not higher than that of the Pediatric Logistic Organ Dysfunction Score-2 (PELOD-2) [area under ROC curve (AUROC) = 0.829 vs. 0.816; p = 0.970]. Yet, and suggested by the authors themselves, as pupil size and lactatemia were not available in their database, this may have reduced the performance of PELOD-2 in their population [1]. In our recent study, AUROC of PELOD-2 including these two parameters was 0.91 in children with suspected infection and in those with low mean blood pressure and hyperlactatemia [2]. In another study in the whole population of critically ill children in one PICU, the performance of pSOFA was considered better than that of PELOD-2 (AUROC = 0.88 vs. 0.87; a difference of low relevance in our opinion) [3]. Unfortunately, it was impossible to obtain from Matics and Sanchez-Pinto additional information regarding the performance of PELOD-2 in the subgroups of children with infection and those with septic shock. Although the databases were different, AUROC of quick SOFA (qSOFA) proposed by Schlapbach et al. [1] appeared lower than that of the quick PELOD-2 (qPELOD-2) reported by us (0.74 vs. 0.82) [2]. Can Schlapbach et al. calculate the qPELOD-2 (and AUROC) on their database? Sepsis-3 definitions in children need further validation [1, 3], and we suggest comparing newly developed pSOFA in its different versions versus validated PELOD-2 used worldwide, and qSOFA versus qPELOD-2 in future studies.