新生儿序贯器官衰竭评分对极低出生体重儿晚发败血症死亡的预测价值

Predictive value of neonatal sequential organ failure assessment score for the mortality in very low birth weight neonates with late-onset sepsis

目的评价新生儿序贯器官衰竭评分(nSOFA)对极低出生体重儿晚发败血症死亡风险的预测价值。方法采用单中心、回顾性病例对照性研究。收集2018—2021年于南京医科大学附属苏州医院(苏州市立医院)新生儿科重症监护室住院的首次患有晚发败血症的95例极低出生体重儿确诊感染时及感染6 h后的nSOFA评分,上述患者以持续使用抗生素后发生的临床结局分为死亡组和存活组。采用受试者工作特征(ROC)曲线评估nSOFA评分对极低出生体重儿晚发败血症死亡风险的预测价值。结果感染后6 h晚发败血症死亡组nSOFA与存活组相比,差异有统计学意义(P<0.01),而在确诊感染时差异无统计学意义(P>0.05)。感染后6 h nSOFA评分预测模型ROC的AUC=0.873(95%CI 0.729~1.00,P=0.000),而确诊感染时AUC=0.541(95%CI 0.32~0.77,P=0.69)。感染后6 h nSOFA评分约登指数最大值为0.687,最佳截断值为6.5分。结论确诊败血症后6 h nSOFA能较好地预测极低出生体重儿的死亡风险。监测nSOFA对改善新生儿脓毒症预后有一定的临床价值。

Objective To evaluate the predictive value of neonatal sequential organ failure assessment(nSOFA)score for predicting the mortality in very low birth weight(VLBW)neonates with late-onset sepsis(LOS).Methods It was a single-center,retrospective,case-control study.A total of 95 VLBW infants with LOS,who were admitted to the Intensive Care Unit,Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital from 2018 to 2021 were selected.Their nSOFA scores at diagnosis and at 6 h post-diagnosis were analyzed.According to the clinical outcome after continuous use of antibiotics,the patients were divided into two groups:a death group and a survival group.The efficiency of nSOFA to predict the mortality of LOS in VLBW neonates was evaluated by a receiver operating characteristic curve.Results The nSOFA scores were statistically different between the death group and the survival group at 6 h post-diagnosis(P<0.01),without statistical difference at diagnosis(P>0.05).For the nSOFA score prediction model,the area under the curve(AUC)at 6 h post-diagnosis was 0.873(95%CI 0.729-1.00,P=0.000),and 0.541 at diagnosis(95%CI 0.32-0.77,P=0.69).The maximum Yoden index at 6 h post-diagnosis was 0.687,and the corresponding decision threshold was 6.5.Conclusions The nSOFA score as 6 h post-diagnosis can predict the mortality of LOS in VLBW infants.Monitoring nSOFA is useful for the improvement of neonatal sepsis outcomes.