摘要
目的评价儿童序贯器官衰竭评分(pediatric sequential organ failure assessment,pSOFA)对感染患儿预后的预测价值。方法对2018年1月1日至2018年12月31日在我院PICU住院治疗的感染或疑似感染患儿进行回顾性分析。收集患儿入院后24 h内所检测的最差的生理指标和实验室指标,采用pSOFA及全身炎症反应综合征(systerm inflammatory reaction syndrome,SIRS)评分进行诊断,纳入符合pSOFA≥2分及SIRS评分≥2分的病例。并对符合的病例分别进行儿童多器官功能衰竭评分(pediatric multiple organ dysfunction score,P-MODS)、儿童器官功能障碍评分-2(pediatric logistic organ dysfunction-2,PELOD-2)、小儿危重病例评分。以住院期间存活或死亡判断预后,分析pSOFA和SIRS不同评分时的死亡情况。采用受试者工作特征曲线评估pSOFA对感染患儿预后的预测价值。结果符合感染及疑似感染的病例共755例,其中符合SIRS评分或pSOFA≥2分的患儿303例,单独符合SIRS≥2分165例,单独符合pSOFA≥2分为85例,两者都符合53例。pSOFA评分2分、3分、4分、5~6分及7~9分的住院病死率分别为8.97%、15.38%、26.09%、57.34%及100%,随着pSOFA评分增加,病死率逐渐升高;SIRS评分2分、3分及4分的住院病死率分别为3.64%、12.64%及4.76%。pSOFA预测死亡的受试者工作特征曲线下面积为0.74(95%CI 0.62-0.86),明显高于其他4种评分。临界值为4分时,其预测预后的敏感性为56%,特异性为82%。结论与SIRS评分、P-MODS、PELOD-2及小儿危重病例评分相比,pSOFA预测PICU感染儿童的住院病死率具有更高的准确性。
Objective To evaluate the predictive value of the pediatric sequential organ failure assessment(pSOFA)in predicting the prognosis of infected children.Methods We performed a retrospective analysis of children with infection or suspected infection who were hospitalized at PICU from January 1,2018 to December 31,2018.The worst physiological and laboratory indicators detected within 24 hours after admission were collected.The pSOFA and systemic inflammatory reaction syndrome(SIRS)score were used for diagnosis.Patients with pSOFA≥2 and SIRS score≥2 were included.Pediatric multiple organ dysfunction score(P-MODS),pediatric logistic organ dysfunction(PELOD-2),and pediatric critical illness score were performed for those patients who met the criteria.Survival or death during hospitalization was used to determine the prognosis,and death conditions with different scores of pSOFA and SIRS were analyzed.Receiver operation characteristic curve was used to evaluate the predictive value of pSOFA for the prognosis of children with infection.Results A total of 755 cases were eligible for infection or suspected infection,among which 303 children were eligible for SIRS and pSOFA score≥2,165 cases were eligible for SIRS score≥2 alone,85 cases were eligible for pSOFA score≥2 alone,and 53 cases were eligible for both.The in-hospital fatality rates of pSOFA 2,3,4,5-6 and 7-9 points were 8.97%,15.38%,26.09%,57.64%and 100%,respectively.With the increase of pSOFA,the fatality rate increased gradually.The in-hospital fatality rates of SIRS score 2,3 and 4 were 3.64%,12.64%and 4.76%,respectively.The area under the receiver operating characteristic curve of pSOFA was 0.74(95%CI 0.62,0.86),which was significantly higher than the other four scores.At a cut-off value of 4 points,it had a sensitivity of 56%and a specificity of 82%to predict prognosis.Conclusion The pSOFA score has the highest accuracy than the SIRS score,P-MODS,PELOD-2 score and pediatric critical illness score in predicting the hospital mortality of PICU-infected chi
作者
关向飞
刘春峰
Guan Xiangfei;Liu Chunfeng(Department of Pediatrics,Shengjing Hospital of China Medical University,Shenyang 110004,China)
出处
《中国小儿急救医学》
CAS
2021年第5期385-388,共4页
Chinese Pediatric Emergency Medicine
基金
辽宁省科技重大专项计划(2020JH1/10300001)
国家自然科学基金面上项目(81971810)。
关键词
脓毒症
儿童序贯器官衰竭评分
预后
Sepsis
Pediatric sequential organ failure assessment
Prognosis
