J Korean Med Sci.  2025 Mar;40(10):e106. 10.3346/jkms.2025.40.e106.

Validation of the Phoenix Criteria for Sepsis and Septic Shock in a Pediatric Intensive Care Unit

• Han CH
• Kim H
• Park M
• Kim SY
• Kim JD
• Sohn MH
• You SC
• Kim KW

• KMID: 2565802
• DOI: http://doi.org/10.3346/jkms.2025.40.e106

Abstract

The applicability of the Phoenix criteria and Phoenix Sepsis Score in higher-resource pediatric intensive care units (PICUs) outside the United States requires further validation. A retrospective cohort study analyzed electronic health records of 1,304 PICU admissions under 18 years old with suspected infection between February 2017 and December 2023. The score was calculated using two methods: 24-hour assessment, based on worst sub-scores within 24 hours of admission, and prompt assessment, using values closest to admission within 6 hours before or after. Based on the 24-hour assessment, in-hospital mortality was 8.3% for sepsis and 10.3% for septic shock. The score demonstrated an area under the precision-recall curve of 0.42 (95% confidence interval, 0.31–0.55) for in-hospital mortality. Results were consistent across both assessment methods. The Phoenix criteria and the Phoenix Sepsis Score are reliable predictors of mortality outcomes. Further investigation in diverse clinical settings is warranted.

Keyword

Sepsis; Septic Shock; Pediatrics; Intensive Care Units; Mortality; Predictive Value of Tests

Figure

• 

  Fig. 1 Bar plots illustrating the calibration of the Phoenix Sepsis Score. The Phoenix Sepsis Score was evaluated using 2 different methods, displayed separately. For each possible value of the Phoenix Sepsis Score, the numbers of cases with suspected infection, in-hospital mortality, and mortality within 1 month are shown. The plots also include Wilson intervals of the binomial distribution (whiskers) for each category.PICU = pediatric intensive care unit.aRepresenting scores calculated from sub-scores based on values closest to the PICU admission time.bRepresenting scores calculated from the worst sub-scores based on values collected within 24 hours after PICU admission.

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  Fig. 2 Comparison of the Phoenix Sepsis Score, the Phoenix-8 Score, and the pSOFA score based on their performance in predicting mortality outcomes in patients with suspected infection. Each score was calculated using 2 different methods, and the AUPRCs and AUROCs were calculated for each of the generated scores. AUPRCs and AUROCs are directly shown with 95% confidence intervals and are also presented with color hit maps: higher values are represented by darker colors.pSOFA = pediatric Sequential Organ Failure Assessment, AUPRC = area under the precision-recall curve, AUROC = area under the receiver operating characteristic curve.aRepresenting scores calculated from sub-scores based on values closest to the PICU admission time.bRepresenting scores calculated from worst sub-scores based on values collected within 24 hours after PICU admission.

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