{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T08:10:19Z","timestamp":1783930219936,"version":"3.55.0"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":193,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatrics International"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In the previous study, persistent inflammation, immunosuppression, and catabolism syndrome in pediatrics (PIICS\u2010p) criteria identified a subgroup with poor long\u2010term prognosis. Pediatric sequential organ failure assessment (pSOFA) score is a well\u2010known predictor of short\u2010term mortality. We hypothesized that combining the pSOFA score and PIICS\u2010p criteria could provide more comprehensive risk stratification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study in a PICU. Included were 285 eligible patients aged zero to 19\u2009years with 15\u2009days or longer of PICU stay between January 2019 and December 2023. The primary outcomes were death during the observation period and time from PICU day 14 to death. Patients were classified on PICU day 14: high pSOFA (&gt;\u20098) or low, subsequently stratified by PIICS\u2010p or not.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The overall mortality rate was 47% (35\/75) in high pSOFA, 32% (8\/25) in low pSOFA\/PIICS\u2010p, and 10% (18\/185) in low pSOFA\/non\u2010PIICS\u2010p group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In a multivariable Cox proportional hazards model, high pSOFA (HR 6.33, 95% CI 3.43\u201311.7,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and low pSOFA\/PIICS\u2010p (HR 3.14, 95% CI 1.28\u20137.69,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012) were identified as significant risk factors for mortality. The Kaplan\u2013Meier curves showed significant differences among the three groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The high pSOFA group showed an early decline in survival. Survival in the low pSOFA\/PIICS\u2010p group was lower than that in the low pSOFA\/non\u2010PIICS\u2010p group, and the difference widened over time.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Integration of pSOFA and PIICS\u2010p enables three\u2010group mortality stratification in critically ill children and early recognition of late\u2010mortality risk among those who appear low risk acutely.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ped.70478","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T07:40:08Z","timestamp":1783928408000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mortality Stratification With Pediatric\n                    <scp>SOFA<\/scp>\n                    and Persistent Inflammation, Immunosuppression, and Catabolism Syndrome"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4343-8654","authenticated-orcid":false,"given":"Shin","family":"Tsubokura","sequence":"first","affiliation":[{"name":"Critical Care Medicine National Center for Child Health and Development  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7444-8137","authenticated-orcid":false,"given":"Norihiko","family":"Tsuboi","sequence":"additional","affiliation":[{"name":"Critical Care Medicine National Center for Child Health and Development  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saki","family":"Endo","sequence":"additional","affiliation":[{"name":"Critical Care Medicine National Center for Child Health and Development  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eisaku","family":"Nashiki","sequence":"additional","affiliation":[{"name":"Critical Care Medicine National Center for Child Health and Development  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4666-2437","authenticated-orcid":false,"given":"Soichiro","family":"Tanimura","sequence":"additional","affiliation":[{"name":"Critical Care Medicine National Center for Child Health and Development  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4995-8442","authenticated-orcid":false,"given":"Shotaro","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"Critical Care Medicine National Center for Child Health and Development  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"issue":"6","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1097\/TA.0b013e318256e000","article-title":"Persistent Inflammation and Immunosuppression: A Common Syndrome and New Horizon for Surgical Intensive Care","volume":"72","author":"Gentile L. F.","year":"2012","journal-title":"Journal of Trauma and Acute Care Surgery"},{"key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.3389\/fimmu.2018.01511","article-title":"Chronic Critical Illness and the Persistent Inflammation, Immunosuppression, and Catabolism Syndrome","volume":"9","author":"Hawkins R. B.","year":"2018","journal-title":"Frontiers in Immunology"},{"issue":"3","key":"e_1_2_12_4_1","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.bja.2023.11.052","article-title":"Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS): A Review of Definitions, Potential Therapies, and Research Priorities","volume":"132","author":"Chadda K. R.","year":"2024","journal-title":"British Journal of Anaesthesia"},{"issue":"4","key":"e_1_2_12_5_1","doi-asserted-by":"crossref","first-page":"297","DOI":"10.2174\/0115733963298459240508050319","article-title":"Persistent Inflammation, Immunosuppression and Catabolism Syndrome in Pediatric Populations: A Brief Perspective","volume":"21","author":"Santarelli M. D.","year":"2025","journal-title":"Current Pediatric Reviews"},{"issue":"5","key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/j.chest.2023.05.002","article-title":"Pediatric Persistent Inflammation, Immunosuppression, and Catabolism Syndrome Prevalence in Sepsis\u2010Related Mortalities: A 23\u2010Year Institutional History","volume":"164","author":"Patterson S. G.","year":"2023","journal-title":"Chest"},{"issue":"2","key":"e_1_2_12_7_1","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1111\/jhn.12798","article-title":"Persistent Inflammation, Immunosuppression and Catabolism Syndrome (PICS) in Critically Ill Children Is Associated With Clinical Outcomes: A Prospective Longitudinal Study","volume":"34","author":"Hauschild D. B.","year":"2021","journal-title":"Journal of Human Nutrition and Dietetics"},{"issue":"2","key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"e281","DOI":"10.1097\/PCC.0000000000003625","article-title":"Application of Persistent Inflammation, Immunosuppression, and Catabolism Syndrome to Critically Ill Children: Single\u2010Center Retrospective Cohort, 2019\u20102023","volume":"26","author":"Tanimura S.","year":"2025","journal-title":"Pediatric Critical Care Medicine"},{"issue":"10","key":"e_1_2_12_9_1","doi-asserted-by":"crossref","first-page":"e172352","DOI":"10.1001\/jamapediatrics.2017.2352","article-title":"Adaptation and Validation of a Pediatric Sequential Organ Failure Assessment Score and Evaluation of the Sepsis\u20103 Definitions in Critically Ill Children","volume":"171","author":"Matics T. J.","year":"2017","journal-title":"JAMA Pediatrics"},{"issue":"2","key":"e_1_2_12_10_1","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1007\/s00134-002-1601-2","article-title":"PIM2: A Revised Version of the Paediatric Index of Mortality","volume":"29","author":"Slater A.","year":"2003","journal-title":"Intensive Care Medicine"},{"issue":"9379","key":"e_1_2_12_11_1","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/S0140-6736(03)13908-6","article-title":"Validation of the Paediatric Logistic Organ Dysfunction (PELOD) Score: Prospective, Observational, Multicentre Study","volume":"362","author":"Leteurtre S.","year":"2003","journal-title":"Lancet"},{"issue":"11","key":"e_1_2_12_12_1","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1097\/00003246-198811000-00006","article-title":"Pediatric Risk of Mortality (PRISM) Score","volume":"16","author":"Pollack M. 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