Modified quick sequental organ failure assesment score with serum procalcitonin and neutrophil and lymphocyte ratio for predicting the outcome for acute febrile encephalopathy in children

Abstract

Background: Procalcitonin (PCT) level is one of known biomarker in septic diagnosis, but limited studies report its benefit in predicting the outcomes of children with sepsis. Modified qSOFA and Neutrophil to lymphocyte ratio (NLR) are simple biomarkers of inflammation that can be measured in routine hematological examination which role in predicting organ dysfunction remain unclear. Objective: To assess the accuracy of modified qSOFA score for predicting outcome in acute febrile encephalopathy. Methods: A prospective observational study at Shri B M Patil Medical College Hospital and Research Centre in Vijayapura aimed to assess the accuracy of modified qSOFA with serum procalcitonin and neutrophil lymphocyte ratio in predicting outcomes of acute febrile encephalopathy in children. The study involved 60 patients with suspected central nervous system infection admitted to the PICU over a 1.5-year period. Clinical assessments and blood investigations were conducted at the point of arrival. Results: Among 60 acute febrile encephalopathy children found that 55%had altered sensorium whereas 45% has intact sensorium. The majority of patients had capillary refill time of less than 3 seconds, with high-risk patients accounting for 35% and low-risk patients making up 65%. High-risk patients comprised 58.3% of the total, while low-risk patients made up 41.7%. 85% of patients were discharged, and 15% died. The progression based on the QSOFA score had a significant association with patients' outcomes, with death being significantlylinked to high risk. Among the 9 patients who died, 88.9% were classified as high-risk. High-risk patients required a PICU stay of more than 3 days, while low-risk patients needed a stay of less than 3 days. Deceased patients had higher modified qSOFA score, and qSOFA score compared to discharged patients. A receiver operating characteristic (ROC) analysis was performed to predict outcomes, with the optimal cut-off value for the qSOFA score and modified qSOFA score being ≥2.50 and ≥4.50, respectively, indicating a higher likelihood of mortality. Conclusion: Modified qSOFA Score and procalcitonin have shown to have superior performance in predicting the outcome of the patients admitted in pediatric intensive care with acute febrile encephalopathy.