OP021 Topic: AS14–Infections: Sepsis and Septic Shock/Antimicrobial Stewardship/Tropical and Parasite Infections/Other: VALIDATION AND APPLICABILITY OF THE PHOENIX SEPSIS SCORE IN LOW-RESOURCE SETTINGS

Abstract

Aims & Objectives: Sepsis and Septic Shock are leading death causes, sepsis diagnosis criteria evolved since 2005 and recently the Phoenix Sepsis Score (PSS) was proposed. Our study pretends to validate and evaluate the applicability of the score in a resource-limited setting. Methods: An observational, multicentric, and retrospective study was performed in 14 hospitals in Bolivia, enrolling septic children added in 2023 and a statistical analysis was carried out to describe its application and validate the new sepsis criteria. Results: 274 patients were enrolled, with an admission diagnosis of sepsis (22,6%), septic shock (63,5%), and 13,9% cases later ruled out; a mortality rate of 29% for sepsis and 36,8% for septic shock was observed. PSS show increased sensitivity (91,1%), specificity (83.7%), and an AUROC of 0.537; better than SIRS (AUROC 0.486; sensitivity 71.1% and specificity 73.9%) and SOFA (AUROC 0.460; sensitivity 58.9% and specificity 66.8%). All the PSS criteria are routinely performed (>83,2% of patients), except Fibrinogen (19,8%) and D-Dimer; the coefficient of Cronbach’s alpha of 0,715 showed acceptable reliability, but some variations in oxygen levels due to the high-altitude geography of hospitals modified the reliability test, reducing to 0.589 the coefficient of Cronbach’s alpha in hospitals above 4000 m.a.s.l.Conclusions: The PSS is applicable in low resource settings, the limited availability of fibrinogen and D-dimer tests does not change the overall reliability of the score, which is acceptable. The high altitude of some hospitals reduces the reliability of PSS, therefore further studies are required to evaluate the correct adaptation of the PSS to high-altitude environments. Keywords: septic shock, Bolivia, Critical care, Children, Sepsis