4种评分系统对脓毒症患儿预后的预测价值

Prognostic value of four scoring systems in children with sepsis

目的:探讨儿童危重病例评分(PCIS)、儿童器官功能障碍评分2(PELOD-2)、儿童多器官功能障碍评分(P-MODS)、儿童年龄适应性序贯器官衰竭评分(pSOFA)在脓毒症患儿预后评估中的作用。方法:采用前瞻性观察研究,以2019年1月—2020年3月期间收住徐州市儿童医院重症医学科的515例脓毒症患儿为研究对象,根据入院28 d结局将患儿分为生存组(n=496)和死亡组(n=19)。绘制受试者工作特征(ROC)曲线评估PCIS、PELOD-2、P-MODS、pSOFA对脓毒症患儿死亡的预测价值,采用Z检验进行ROC曲线下面积(AUC)的比较。结果:(1)死亡组PELOD-2评分、P-MODS评分、pSOFA评分,均高于生存组[6(5,8)vs. 3(2,4),P=0.000;5(4,7)vs. 3(2,4),P=0.000;9(7,12)vs. 4(3,6),P=0.000],PCIS低于生存组[80(77,87)vs. 85(81,92),P=0.000]。(2)PCIS、PELOD-2、P-MODS、pSOFA评分预测脓毒症患儿死亡的AUC分别为0.787(0.703~0.857)、0.925(0.862~0.965)、0.814(0.732~0.879)、0.886(0.815~0.937),预测界值分别为78、5、4、7。(3)PELOD-2评分预测脓毒症患儿死亡的AUC,均显著高于PCIS、P-MODS评分(Z=2.298,P=0.022;Z=2.016,P=0.044),较pSOFA评分虽有升高趋势,但差异无统计学意义(Z=0.788,P=0.431)。结论:PCIS、PELOD-2、P-MODS、pSOFA评分均可较好地预测脓毒症患儿的预后,尤以PELOD-2评分更显著。

Objective: To investigate the prognostic value of pediatric clinical illness score(PCIS), pediatric logistic organ dysfunction-2(PELOD-2), pediatric multiple organ dysfunction score(P-MODS), pediatric age-adapted sequential organ failure assessment(pSOFA) in children with sepsis. Methods: Prospective observational studies were used. From January 2019 to March 2020, a total of 515 children with sepsis admitted to the intensive care department of Xuzhou children’s Hospital were included. According to the 28-day outcome of admission, the children were divided into survival group(n=496) and death group(n=19). The prognostic value of PCIS, PELOD-2, P-MODS and pSOFA on mortality of children with sepsis was evaluated by receiver operating characteristic(ROC) curve. The area under ROC curve(AUC) was compared by Z test. Results:(1) The PELOD-2, P-MODS, and pSOFA in the death group were higher than those in the survival group(6[5, 8] vs. 3[2, 4], P=0.000;5[4, 7] vs. 3[2, 4], P=0.000;9[7, 12] vs. 4[3, 6], P=0.000), PCIS was lower than the survival group(80[77, 87] vs. 85[81, 92], P=0.000).(2)The AUC of PCIS, PELOD-2, P-MODS, and pSOFA scores to predict death in children with sepsis were 0.787(0.703-0.857), 0.925(0.862-0.965), 0.814(0.732-0.879), 0.886(0.815-0.937), the predicted cut-off values were 78, 5, 4, and 7, respectively.(3) The AUC of PELOD-2 was significantly higher than that of PCIS and P-MODS(Z=2.298, P=0.022;Z=2.016, P=0.044), but there was no significant difference between PELOD-2 and pSOFA(Z=0.788, P=0.431). Conclusion: PCIS, PELOD-2, P-MODS and pSOFA can predict the prognosis of children with sepsis, especially PELOD-2 score is more significant.