(1587) Phoenix Sepsis Criteria Applied to a Pediatric Sepsis Cohort Defined by SIRS and Organ Dysfunction

Introduction: In 2024, a Society of Critical Care Medicine task force updated the pediatric sepsis definition from the presence of suspected or confirmed infection, and a systemic inflammatory response (SIRS) with organ dysfunction, to a novel data driven definition. Our objective is to identify how many patients previously identified as having severe sepsis would continue to meet the new definition.

Methods: We performed a secondary analysis of the Phenotyping Sepsis-Induced Multiple Organ Failure (PHENOMS) cohort of 401 children with suspected or confirmed infection, two of four SIRS criteria and organ dysfunction enrolled from one of nine US Pediatric Intensive Care Units between 2015-2017. We calculated a modified Phoenix Sepsis Criteria Score (mPSC) for participants and compared those children with mPSC of greater than or equal to 2 or less than 2 according to the 2024 definition.

Results: Of 401 children, 132 (33%) did not meet mPSC definitions. While children meeting mPSC had more organ dysfunction, the total mortality did not differ. One in 4 children requiring extracorporeal membrane oxygenation and 1 in 4 mortalities did not meet the mPSC definition. In logistic regression models, in the complete cohort, hematologic (OR 4.4, 95% CI: 1.8 - 10.2 , p-value = 0.001), central nervous system (OR 2.3, 95% CI: 1.0 – 5.1, p-value = 0.046) and renal failure (OR: 3.2, 95% CI:1.2 – 7.9 , p-value = 0.017) predicted mortality; in the mPSC subgroup pulmonary (OR: 3.6, 95% CI:1.3 – 13.3 , p-value = 0.030) and hematologic failure (OR 5.6, 95% CI: 2.2 – 14.5, p-value = 0.0003) were significant predictors. In the mPSC excluded subgroup, only renal failure predicted mortality (OR 9.6, 95% CI 1.1 – 73.0, p-value = 0.028).

Conclusions: Application of the new pediatric sepsis definition excluded 1/3 of participants, and ¼ of ECMO cases and mortalities. Further study of the impact of the 2024 data-driven organ dysfunction definition on pediatric sepsis research, patient safety, and clinical benchmarking efforts is warranted.