Background/Objectives: Early identification of pediatric sepsis complications in intensive care is challenging and requires improved diagnostic tools. This study aimed to compare the Phoenix Sepsis Score (PSS), pSOFA, PELOD-2, and PRISM III in assessing clinical complexity in children with septic and critical conditions in the PICU and to identify the most suitable scale for this patient cohort. Methods: Data were collected prospectively from 53 children between June 2022 and January 2024. Patients were categorized into septic (n = 42) and non-infectious SIRS (n = 11) and further classified by outcome—with/without complications (n = 23/30). The predictive accuracy of the scoring systems was evaluated by discrimination and calibration and by recalibration for the PSS for improved performance. Results: Respiratory (18.8%) and neurological complications (9.4%) were the most common adverse events. Clinical deterioration was observed in 43.4% of cases, including one fatality. Patients with complications stayed longer in the PICU (14 ± 10 days). In the patients with complications, all scoring systems had higher median values. Only PSS showed a significant difference (p = 0.0023). PSS demonstrated the highest overall predictive accuracy (76.2%) outperforming PRISM III (62.3%) and PELOD-2 (58.5%). The pSOFA scale showed high accuracy (88.0%) in identifying patients without complications. The strongest association was between chronic disease (hazard ratio Exp(B) = 1.718) and deteriorations, while mechanical ventilation suggested a reduced risk of complications (Exp(B) = 0.509). Conclusions: PSS showed superior predictive accuracy (76.2%) for deteriorations in pediatric patients with suspected infection and proved adaptable for further validation in larger populations.

Background Multisystem Inflammatory Syndrome in children related to COVID-19 (MIS-C) is a new condition the aftermath of which is yet to be studied both in Bulgaria and globally. Up to mid December 2020, world COVID-19 fatalities are put at 1 582 674, according WHO statistics. Case Presentation Summary We present a 15 years old patient with MIS-C, diagnosed with acute abdomen, operated andtreated for septic shock syndrome. The current situation represents a major clinical challenge in part due to the complex differential diagnosis involved: acute abdomen, septic shock, autoimmune diseases (Lupus erythematosus, Juvenile idiopathic arthritis, Kawasaki disease, Acquired immune deficiency, Crohn`s disease, Ulcer colitis), acute myocarditis. At the same time, other symptoms observed in children with COVID-19 such as skin rashes, lymphadenopathy, conjunctivitis are not presented inour patient. We did not observe any myocardial injury, however she went into an acute vasodilatory shock with tachycardia, reduced kidney perfusion pressure and oliguria. Learning Points/Discussion Effects of SARS-CoV-2 infection on patients will be a subject of analysis and clinical research. Differential diagnosis of the multisystem inflammation syndrome in children, clinical experience and new therapeutic strategies are the key to reducing mortality and long-term complications in the affected patients.

Background: Pediatric sepsis is a life-threatening emergency and remains complex to diagnose promptly due to the absence of universally reliable biomarkers. C-reactive protein (CRP) and procalcitonin (PCT) are widely used but have limited effectiveness. We evaluated the diagnostic reliability of presepsin and soluble mannose receptor (sMR) and identified optimal biomarker combinations for distinguishing sepsis from non-infectious systemic inflammatory response syndrome (SIRS) in children. Methods: A total of 80 children were enrolled in this prospective study, including 53 consecutive admissions to the pediatric intensive care unit (PICU) (sepsis, n = 42; non-infectious SIRS, n = 11) and 27 healthy controls. The serum levels of new biomarkers presepsin and soluble mannose receptor (sMR) levels were quantified by ELISA methods and their diagnostic reliability (both individually and combined with CRP and PCT) was assessed using receiver operating characteristic (ROC) curves and multivariate logistic regression. Results: Significantly higher concentrations of all measured markers were found both in septic and other critically ill patients than in healthy controls (p < 0.05). No single biomarker reliably differentiated sepsis from non-infectious SIRS. The sMR + CRP + PCT combination demonstrated the highest diagnostic accuracy (AUC = 0.78, p = 0.0007), surpassing the CRP + PCT model (AUC = 0.71, p = 0.0087). Conclusions: The addition of sMR to the established markers CRP and PCT improves the diagnostic effectiveness in pediatric sepsis. Larger multicenter studies are warranted to confirm clinical utility.

Introduction: The history of sepsis dates back to ancient Greece, with its name being derived from the Greek word sepo, meaning decay. A large multicentered study conducted in 2020 reported that sepsis accounts for 48.9 million cases annually, resulting in over 11 million fatalities. Strengthening prevention, early diagnosis, and appropriate treatment of sepsis remains a primary strategy and objective of the World Health Organization, as outlined in the resolutions of the Seventeenth World Health Assembly. Aim: The aim of this article is to investigate the clinical profile and etiological structure of diseases in children with septic and critical conditions hospitalized between June 2022 and January 2024 in the pediatric intensive care unit of a Bulgarian university hospital. Materials and Methods: Over an 18-month prospective period, a total of 53 children, aged from 7 days to 18 years, with acute-onset infectious diseases or in critical conditions meeting predefined inclusion criteria were evaluated. For the purposes of the study, medical history, physical examination, and laboratory methods to determine complete blood count, blood gas analysis, coagulation and biochemical parameters, and microbiological analysis of blood were used. Results: The relative share of children with diseases of infectious etiology was 79.2% (septic group), while those with non-infectious critical conditions accounted for 20.8%. The 13–48-month age group represented the highest relative proportion of hospitalizations (30.2%). Lower respiratory tract infections dominated in the septic group (53.4%), while intoxications were the leading cause in the critical condition group (36.4%). Microbiological identification was achieved in 42.8% of infections, with bacterial pathogens predominating over viral ones (55.6% vs. 44.4%). Escherichia coli, Streptococcus pneumoniae, and Staphylococcus aureus were among the bacterial species most frequently identified as causative agents of infections, associated with sepsis. Long-term complications following intensive treatment were observed in 9.4%. Conclusion: Knowledge about the microbial spectrum of sepsis in childhood allows applying etiological rather than empirical antibiotic therapy, and the modern diagnostic methods ensure its timely initiation and reduction of the long-term disability risk.