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Sci Rep. 2019 Jan 23;9(1):424. doi: 10.1038/s41598-018-36743-z.

The Pediatric Sepsis Biomarker Risk Model (PERSEVERE) Biomarkers Predict Clinical Deterioration and Mortality in Immunocompromised Children Evaluated for Infection.

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Division of Pediatric Critical Care, Texas Children's Hospital, 6651 Main St. E1470.36, Houston, TX, 77030, USA.
Division of Pediatric Critical Care, Riley Hospital for Children at the University of Indiana Health, 705 Riley Hospital Dr., Indianapolis, IN, 46202, USA.
Division of Pediatric Critical Care, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave MLC 2005, Cincinnati, OH, 45229, USA.
Division of Pediatric Infectious Disease, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave MLC 7017, Cincinnati, OH, 45229, USA.


Pediatric sepsis and bacterial infection cause significant morbidity and mortality worldwide, with immunocompromised patients being at particularly high risk of rapid deterioration and death. This study evaluated if PERSEVERE, PERSEVERE-II, or the PERSEVERE biomarkers, can reliably estimate the risk of clinical deterioration and 28-day mortality among immunocompromised pediatric patients. This is a single-center prospective cohort study conducted from July 2016 through September 2017 incorporating 400 episodes of suspected bacterial infection from the inpatient units at Cincinnati Children's Hospital Medical Center, a large, tertiary care children's hospital. The primary analysis assessed clinical deterioration within 72 hours of evaluation for infection. Secondarily, we assessed 28-day mortality. Clinical deterioration was seen in 15% of subjects. Twenty-eight day mortality was 5%, but significantly higher among critically ill patients. Neither PERSEVERE nor PERSEVERE-II performed well to predict clinical deterioration or 28-day mortality, thus we derived new stratification models using the PERSEVERE biomarkers with both high sensitivity and negative predictive value. In conclusion, we evaluated previously validated biomarker risk models in a novel population of largely non-critically ill immunocompromised pediatric patients, and attempted to stratify patients based on a new outcome metric, clinical deterioration. The new highly predictive models indicate common physiologic pathways to clinical deterioration or death from bacterial infection.

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