Divergent PICU lengths of stay despite identical phoenix sepsis scores: heterogeneity in pediatric sepsis outcomes according to system involvement profiles
- 1Department of Pediatric Critical Care Medicine, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, Sichuan, China
Abstract
Objective: This study examined how different subsystem involvement patterns in the Phoenix Sepsis Score relate to PICU length of stay among children with sepsis, focusing on patients with identical total scores, and explored clinical factors associated with these differences.
Methods: We retrospectively included 107 children with sepsis admitted to a single PICU (2024–2025). Patients were grouped by the number of affected Phoenix subsystems (respiratory, coagulation, circulatory, neurological): single-system (n = 37), dual-system (n = 62), and multi-system (n = 8). We further compared the largest subgroups with identical total scores of 2—isolated respiratory involvement (n = 29) versus respiratory-coagulation involvement (n = 59). Multivariable logistic regression identified predictors of prolonged PICU stay (≥10 days), and the association between IMV and PICU length of stay was further explored.
Results: Respiratory and/or coagulation involvement accounted for 89.7% (96/107) of cases, with the respiratory–coagulation combination being most frequent (55.1%). The multi-system group had the highest total scores, lactate levels, and mortality (37.5%, all P < 0.05). Despite identical total scores [2 (2, 2), P = 0.457], the isolated respiratory group had significantly prolonged PICU stay [10 (9, 12) vs. 6 (4, 8) days, P < 0.001], higher ventilation rates (100% vs. 25.4%, P < 0.001), and longer ventilation duration [6 (4, 7) vs. 0 (0, 0) days, P < 0.001]. Invasive ventilation was the strongest risk factor for prolonged stay (OR=18.80, 95% CI: 3.78–123.24, P < 0.001). Adjusting for ventilation attenuated the group effect from OR=6.92 (P < 0.001) to OR=1.27 (P = 0.739), suggesting that the subgroup difference in PICU length of stay was largely explained by the higher IMV use in the single-respiratory group. Since IMV is part of the Phoenix respiratory subscore, this attenuation likely reflects shared information rather than formal mediation.
Conclusions: In septic children with the same Phoenix total score, different system involvement patterns yield substantially different outcomes and resource use. A respiratory subsystem score ≥2 signals high risk of prolonged PICU stay, largely explained by the greater need for invasive ventilation. The total Phoenix score alone is insufficient for resource planning; the respiratory component may provide additional information beyond the total score.
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BibTeX
@article{jiang2026divergent,
title = {{Divergent PICU lengths of stay despite identical phoenix sepsis scores: heterogeneity in pediatric sepsis outcomes according to system involvement profiles}},
author = {Zhen Jiang and Lijuan Wu and Xinyue Zhou and Jing Xu and Xiaxia Xiong and Jian Chen and Yuhang Hu},
journal = {Frontiers in Pediatrics},
year = {2026},
month = oct,
doi = {10.3389/fped.2026.1986840},
url = {https://doi.org/10.3389/fped.2026.1986840},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Divergent PICU lengths of stay despite identical phoenix sepsis scores: heterogeneity in pediatric sepsis outcomes according to system involvement profiles
AU - Zhen Jiang
AU - Lijuan Wu
AU - Xinyue Zhou
AU - Jing Xu
AU - Xiaxia Xiong
AU - Jian Chen
AU - Yuhang Hu
PY - 2026
DA - 2026/10/21
JO - Frontiers in Pediatrics
DO - 10.3389/fped.2026.1986840
UR - https://doi.org/10.3389/fped.2026.1986840
AB - Objective: This study examined how different subsystem involvement patterns in the Phoenix Sepsis Score relate to PICU length of stay among children with sepsis, focusing on patients with identical total scores, and explored clinical factors associated with these differences. Methods: We retrospectively included 107 children with sepsis admitted to a single PICU (2024–2025). Patients were grouped by the number of affected Phoenix subsystems (respiratory, coagulation, circulatory, neurological): single-system (n = 37), dual-system (n = 62), and multi-system (n = 8). We further compared the largest subgroups with identical total scores of 2—isolated respiratory involvement (n = 29) versus respiratory-coagulation involvement (n = 59). Multivariable logistic regression identified predictors of prolonged PICU stay (≥10 days), and the association between IMV and PICU length of stay was further explored. Results: Respiratory and/or coagulation involvement accounted for 89.7% (96/107) of cases, with the respiratory–coagulation combination being most frequent (55.1%). The multi-system group had the highest total scores, lactate levels, and mortality (37.5%, all P < 0.05). Despite identical total scores [2 (2, 2), P = 0.457], the isolated respiratory group had significantly prolonged PICU stay [10 (9, 12) vs. 6 (4, 8) days, P < 0.001], higher ventilation rates (100% vs. 25.4%, P < 0.001), and longer ventilation duration [6 (4, 7) vs. 0 (0, 0) days, P < 0.001]. Invasive ventilation was the strongest risk factor for prolonged stay (OR=18.80, 95% CI: 3.78–123.24, P < 0.001). Adjusting for ventilation attenuated the group effect from OR=6.92 (P < 0.001) to OR=1.27 (P = 0.739), suggesting that the subgroup difference in PICU length of stay was largely explained by the higher IMV use in the single-respiratory group. Since IMV is part of the Phoenix respiratory subscore, this attenuation likely reflects shared information rather than formal mediation. Conclusions: In septic children with the same Phoenix total score, different system involvement patterns yield substantially different outcomes and resource use. A respiratory subsystem score ≥2 signals high risk of prolonged PICU stay, largely explained by the greater need for invasive ventilation. The total Phoenix score alone is insufficient for resource planning; the respiratory component may provide additional information beyond the total score.
SN - 2296-2360
ER -