Timing of Phoenix Sepsis Score Risk Stratification Relative to Hydrocortisone Treatment in Sepsis

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PSS risk strata were based on the most severe organ dysfunction measurements during the first 12 hours after PICU admission.
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Hydrocortisone began at median 4.7 hours in high-risk and 4.1 hours in low-risk patients, so some classification measurements may have followed treatment initiation.
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The authors’ letter notes that treatment-related changes in organ dysfunction could affect PSS classification, but whether reclassification occurred or influenced estimates is uncertain.
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The propensity model included 12-hour PRISM III scores and refractory shock, covariates that may include posttreatment information and may not be suitable baseline confounders.
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The letter proposes analyses using shared pretreatment eligibility for an admission-time decision or pretreatment scores among eligible, untreated children at 12 hours.

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