简化小儿危重病例评分体系评估危重患儿预后的价值

Value of Simplified Pediatric Critical Illness Scoring System in Assessing Prognosis of Critical Children

目的探讨儿童危重病例评分体系(PCIS)及其简化评分系统对PICU儿童预后预测的价值与相关性。方法对入住PICU的239例患儿进行PCIS,以住院期间生存状态作为金标准,分别用PCIS、简化1(PCIS 10项指标中减Pa02和pH)、简化2(简化1减BUN或SCr)、简化3(简化2减血钠和血钾)进行判断,采用Pearson相关和受试者工作特征曲线(ROC)统计推断。结果 PCIS及各简化评分分值呈显著正相关,P<0.01。当Youden指数最大时,PCIS、简化1、简化2和简化3预测院内死亡的敏感度分别是0.662、0.646、0.600和0.585,特异性分别是0.885、0.891、0.787和0.799。与随机面积0.5比较,PCIS及各简化评分系统预测院内死亡的ROC曲线下面积均有统计学意义(P=0.000);简化3的面积小于其他3种评分方法(P<0.01),简化2和简化1的面积比较差异无统计学意义(P>0.05),但二者均小于PCIS的面积(P<0.05)。结论 PCIS及各简化评分系统对危重病患儿预后预测均有一定价值,可靠性依次是PCIS、简化1、简化2和简化3,基层医院可根据情况试用简化评分系统。

Objective To investigate the value and relationship of pediatric critical illness scoring system （PCIS） and simplified PCIS in predicting prognosis of PICU children. Methods Totally 239 PICU children were scored by PCIS. Prognosis were judged by simplifier 1 （Pa0e and pH were deleted from PCIS 10 items） ,simplifier 2 （serum urea nitrogen or creatinine was deleted from simplifier 1） ,simplifier 3 （plasma sodium and potassium were deleted from simplifier 2） with survival situation during hospitalization served as a ＂gold standard＂ , statistic meth- ods were Pearson relationship analysis and receiver operating characteristic curve （ROC）. Results The PCIS and all simplified PCIS had a positively correlation each other（P^0.01）. The sensitivity of PCIS, simplifier 1, simplifier 2,and simplifier 3 were 0. 662,0. 646,0. 600 and 0. 585,the specificity were 0. 885,0. 891,0. 787 and 0. 799 respectively when Youden index was the bigest. The area of the PCIS and all simplified PCIS which predict in-hospital death increased significantly when compared with the randomly area 0. 5（P=0. 000）. The area of simplifier 3 were less than those of the other simplified PCIS（P〈0.01）. No significant difference was found in areas of ROC between the simplifier 2 and simplifier 1 （P〉0.05） ,but the area of them were less than those of PCIS （P〈0.05）. Conclusion The PCIS and all simplified PCIS are valuable for predicting prognosis of critical children with the accuracy in turn being PCIS, simplifier 1, simplifier 2,and simplifier 3. Simplified PCIS can be considered in primary hospital.