Treatise:Mechanism and Practice

Development and validation of a multi-dimensional pediatric sepsis early warning score based on routine laboratory indicators

  • Tao HUANG ,
  • Xiaojuan LUO ,
  • Fengpiao HUANG ,
  • Xiaoying FU ,
  • Yunsheng CHEN ,
  • Ke CAO
Expand
  • Department of Laboratory Medicine,Shenzhen Children's Hospital,Shenzhen 518038,Guangdong,China

Received date: 2026-01-27

  Online published: 2026-06-15

Abstract

Objective To develop and externally validate a multidimensional Early Warning Scoring Scale (SEWS) for pediatric sepsis, grounded exclusively in routinely available laboratory parameters reflecting four pathophysiological domains: infection, coagulation dysfunction, impaired tissue perfusion, and depletion of host physiological reserves. Methods We conducted a retrospective cohort study involving 193 children with confirmed infection admitted to Shenzhen Children′s Hospital between January 2021 and December 2023. Participants were stratified into two clinically defined groups: the sepsis group (n = 92) and the non-sepsis infection group (n = 101), based on consensus diagnostic criteria (e.g., International Pediatric Sepsis Consensus Conference definitions). Comparative analyses of baseline laboratory parameters were performed between groups. Candidate variables were initially selected using univariate analysis and area under the receiver operating characteristic curve (AUC-ROC) evaluation; subsequently, independent predictors of pediatric sepsis were identified via multivariable logistic regression. A weighted scoring scale—the SEWS—was derived directly from regression coefficients. Internal model performance was rigorously assessed, and external validation was carried out using an independent cohort of 40 consecutive cases collected prospectively from January to April 2024. Results Multivariable logistic regression identified six independent predictors of pediatric sepsis: Procalcitonin (PCT), international normalized ratio (INR), myoglobin, albumin, hemoglobin (Hb), and mean platelet volume (MPV) (all P < 0.05). The composite prediction model achieved an AUC of 0.983 (95%CI: 0.969 - 0.997), significantly outperforming any single biomarker. The SEWS demonstrated excellent discriminative ability in the derivation cohort: sensitivity = 94.6%, specificity = 92.1%, and AUC = 0.981 (95%CI: 0.967 - 0.995) at an optimal cutoff score of ≥ 6 points. In the external validation cohort (n = 40), SEWS maintained high sensitivity (100%) and strong specificity (84.0%). Conclusions The SEWS is a pragmatic, multidimensional clinical tool built solely on routinely measured laboratory parameters. It exhibits robust diagnostic accuracy for early identification of pediatric sepsis, with a score of ≥ 6 conferring high positive predictive value. This evidence supports its integration into clinical workflows to facilitate timely risk stratification and prompt therapeutic intervention.

Cite this article

Tao HUANG , Xiaojuan LUO , Fengpiao HUANG , Xiaoying FU , Yunsheng CHEN , Ke CAO . Development and validation of a multi-dimensional pediatric sepsis early warning score based on routine laboratory indicators[J]. The Journal of Practical Medicine, 2026 , 42(11) : 2077 -2082 . DOI: 10.3969/j.issn.1006-5725.2026.11.024

References

[1] 黄翰武, 赵喆, 王义, 等. 2024年《儿童脓毒症和脓毒性休克的国际共识Phoenix标准》解读[J]. 中国实用儿科杂志, 2024, 39(6): 409-414. doi: 10.19538/j.ek2024060602 .
[2] SCHLAPBACH L J, STRANEY L, ALEXANDER J, et al. Mortality related to invasive infections, sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002-13: A multicentre retrospective cohort study[J]. Lancet Infect Dis, 2015, 15(1): 46-54. doi: 10.1016/S1473-3099(14)71003-5 .
[3] DE SOUZA D C, MACHADO F R. Epidemiology of pediatric septic shock[J]. J Pediatr Intensive Care, 2019, 8(1): 3-10. doi: 10.1055/s-0038-1676634 .
[4] 王莹, 陆国平, 张育才, 等. 儿童脓毒性休克(感染性休克)诊治专家共识(2015版)[J]. 中华儿科杂志, 2015, 53(10): 739-744. doi: 10.3760/cma.j.issn.0578-1310.2015.08.009 .
[5] LIN L, HAN Z, AN F, et al. Aptamer-based biosensors for the diagnosis of sepsis[J]. J Nanobiotechnology, 2021, 19(1): 216. doi: 10.1186/s12951-021-00959-5 .
[6] XIANG H, REN L, WANG Y, et al. Clinical value of pediatric sepsis-induced coagulopathy score in diagnosis of sepsis-induced coagulopathy and prognosis in children[J]. J Thromb Haemost, 2021, 19(12): 2930-2937. doi: 10.1111/jth.15500 .
[7] ZHOU W Q, RAO H P, DING Q M, et al. Soluble CD14 subtype in peripheral blood is a biomarker for early diagnosis of sepsis[J]. Lab Med, 2020, 51(6): 614-619. doi: 10.1093/labmed/lmaa015 .
[8] HE Y D, WOHLFORD E M, UHLE F, et al. The optimization and biological significance of a 29-host-immune-mRNA panel for the rapid diagnosis of acute infection and sepsis[J]. J Pers Med, 2021, 11(8): 735. doi: 10.3390/jpm11080735 .
[9] 应佳云, 刘婷彦, 周文彬, 等. 《2024年国际共识标准:儿童脓毒症和脓毒性休克》解读[J]. 中国小儿急救医学, 2024, 31(5): 322-327. doi:10.3760/cma.j.issn.1673-4912.2024.05.001 .
[10] SCHLAPBACH L J, WATSON R S, SORCE L R, et al. International consensus criteria for pediatric sepsis and septic shock[J]. JAMA, 2024, 331(8):665-674. doi:10.1001/jama.2024.0179 .
[11] ZHU L, CHEN Z, ZHANG H, et al. Explainable AI unravels sepsis heterogeneity via coagulation-inflammation profiles for prognosis and stratification[J]. Nat Commun, 2025, 16(1): 10396. doi: 10.1038/s41467-025-65365-z .
[12] LIU Y S, JIANG J L, YUAN H, et al. Dynamic increase in myoglobin level is associated with poor prognosis in critically ill patients: A retrospective cohort study[J]. Front Med (Lausanne), 2024, 10: 1337403. doi: 10.3389/fmed.2023.1337403 .
[13] LIU Y, ZHENG C, LIU X, et al. Early prediction of sepsis-induced cardiorenal syndrome: Superiority of myoglobin over troponin I[J]. Ren Fail, 2025, 47(1): 2542523. doi: 10.1080/0886022X.2025.2542523 .
[14] 宋景春, 丁仁彧, 吕奔, 等. 脓毒症性凝血病诊疗中国专家共识(2024版)[J]. 解放军医学杂志, 2024, 49(11): 1221-1236. doi: 10.11855/j.issn.0577-7402.1189.2024.0918 .
[15] KURMANA M K, KUMHAR M, TIWARI R K, et al. Prognostic Utility of Prothrombin Time-International Normalized Ratio, Interleukin-6, and High-Density Lipoprotein Levels in Patients With Severe Sepsis[J]. Cureus, 2025, 17(9): e92360. doi: 10.7759/cureus.92360 .
[16] 耿方敏, 贺元旦, 李文娟, 等. 不同DIC评分系统对脓毒症患者凝血功能障碍早期诊断和预后预测的价值[J]. 实用医学杂志, 2024, 40(2): 248-253. doi: 10.3969/j.issn.1006-5725.2024. 02.021 .
[17] SHAABAN H A, SAFWAT N. Mean platelet volume in preterm: A predictor of early onset neonatal sepsis[J]. J Matern Fetal Neonatal Med, 2020, 33(2): 206-211. doi: 10.1080/14767058. 2018.1488161 .
[18] 王仙琦, 张斌, 张琪, 等. 基于单细胞测序分析脓毒症早期血小板数量和功能变化[J]. 实用医学杂志, 2024, 40(9): 1218-1223. doi: 10.3969/j.issn.1006-5725.2024.09.007 .
[19] CAO Y, SU Y J, GUO C R, et al. Albumin level is associated with short-term and long-term outcomes in sepsis patients admitted in the ICU: A large public database retrospective research[J]. Clin Epidemiol, 2023, 15: 263-276. doi: 10.2147/CLEP.S396247 .
[20] 赵国敏, 张辉, 叶朴聪, 等. 乳酸脱氢酶与白蛋白比值对脓毒症相关急性肾损伤患者短期预后的影响[J]. 实用医学杂志, 2024, 40(13): 1803-1807. doi: 10.3969/j.issn.1006-5725.2024. 13.007 .
[21] ZHANG T, YE B, SU J J. Prognostic value of albumin-related ratios in HBV-associated decompensated cirrhosis[J]. J Clin Lab Anal, 2022, 36(4): e24338. doi: 10.1002/jcla.24338 .
[22] ZHU Y, ZHENG X, HUANG K, et al. Mortality prediction using clinical and laboratory features in elderly patients with severe community-acquired pneumonia[J]. Ann Palliat Med, 2021, 10(10): 10913-10923. doi: 10.21037/apm-21-2537 .
[23] MAIGARI I M, JIBRIN Y B, GWALABE S A, et al. Diagnostic usefulness of serum procalcitonin in patients with bacterial sepsis in a tertiary hospital in Nigeria[J]. Niger J Clin Pract, 2023, 26(10): 1436-1443. doi: 10.4103/njcp.njcp_250_22 .
[24] 杨丹曦. ICU可疑感染患者中脓毒症临床预测模型的建立与验证[D]. 长春: 吉林大学, 2023.
[25] ISLAM K R, PRITHULA J, KUMAR J, et al. Machine learning-based early prediction of sepsis using electronic health records: A systematic review[J]. J Clin Med, 2023, 12(17): 5658. doi: 10.3390/jcm12175658 .
Outlines

/