不同新生儿危重评分对超低体重儿死亡风险的预测价值比较

Comparison of different neonatal illness severity scores in predicting mortality risk of extremely low birth weight infants

目的:比较不同危重评分对超低体重儿死亡风险的预测价值。方法:收集2019年1月1日至2020年1月1日南京医科大学附属儿童医院、南京医科大学附属妇产医院、南京医科大学第一附属医院新生儿科收治的所有超低体重儿,排除入院年龄1 h及以上、胎龄37周及以上、各项评分所需资料不全者。收集患儿的临床资料,计算患儿新生儿危重病例评分(NCIS)、新生儿急性生理学评分Ⅱ(SNAP-Ⅱ)、新生儿急性生理学评分围产期补充Ⅱ(SNAPPE-Ⅱ)、新生儿临床危险指数(CRIB)和新生儿临床危险指数Ⅱ(CRIB-Ⅱ)。比较死亡组与存活组的各项危重评分,采用受试者操作特征曲线评估各项危重评分对超低体重儿死亡风险的预测价值,并采用Pearson相关分析法分析各项危重评分与超低体重儿出生体重和胎龄的相关性。结果:共纳入192例超低体重儿,其中存活114例,死亡78例。死亡组与存活组出生体重、胎龄及阿普卡评分差异均有统计学意义(均P<0.01)。死亡组与存活组NCIS、SNAP-Ⅱ、SNAPPE-Ⅱ、CRIB和CRIB-Ⅱ评分差异均有统计学意义(均P<0.01),但CRIB对患儿死亡风险的预测价值相对较高,其曲线下面积为0.787,敏感度为0.678,特异度为0.804,约登指数为0.482。各评分与超低体重儿出生体重和胎龄均存在一定的相关性(均P<0.05),其中CRIB-Ⅱ和CRIB与超低体重儿出生体重和胎龄的相关系数较大,而NCIS与超低体重儿出生体重和胎龄的相关系数在五种评分中均最小(分别为0.191和0.244)。结论:五种危重评分中,CRIB对于超低体重儿的死亡风险预测价值更高,而我国主导推广的NCIS的敏感度及特异度相对较低,需要进一步修订以适应临床需要。

Objective:To compare different illness severity scores in predicting mortality risk of extremely low birth weight infants(ELBWI).Methods:From January 1st,2019 to January 1st,2020,all ELBWI admitted in the Children’s Hospital of Nanjing Medical University,Nanjing Maternity and Child Health Care Hospital and the First Affiliated Hospital of Nanjing Medical University were included in the study.ELBWI with admission age ≥1 h,gestational age ≥37 weeks and incomplete data required for scoring were excluded.The clinical data were collected,neonatal critical illness score(NCIS),score for neonatal acute physiology version Ⅱ(SNAP-Ⅱ),simplified version of the score for neonatal acute physiology perinatal extension(SNAPPE-Ⅱ),clinical risk index for babies(CRIB) and CRIB-Ⅱ were calculated.The scores of the fatal group and the survival group were compared,and the receiver operating characteristic(ROC) curve was used to evaluate the predictive value of the above illness severity scores for the mortality risk of ELBWI.Pearson correlation analysis was used to analyze the correlation between illness scores and birth weight,illness scores and gestational age.Results:A total of 192 ELBWI were finally included,of whom 114 cases survived(survival group) and 78 cases died(fatal group).There were significant differences in birth weight,gestational age and Apgar scores between fatal group and survival group(allP<0.01).There were significant differences in NCIS,SNAP-Ⅱ,SNAPPE-Ⅱ,CRIB and CRIB-Ⅱ between fatal group and survival group(allP<0.01).The CRIB had a relatively higher predictive value for the mortality risk.Its area under the ROC curve(AUC) was 0.787,the sensitivity was 0.678,the specificity was 0.804,and the Youden index was 0.482.The scores of NCIS,SNAP-Ⅱ,SNAPPE-Ⅱ,CRIB and CRIB-Ⅱ were significantly correlated with birth weight and gestational age(allP<0.05).The correlation coefficients of CRIB-Ⅱ and CRIB with birth weight and gestational age were relatively large,and the correlations coefficients of NCIS with birth weight and gestational age were the smallest(0.191 and 0.244,respectively).Conclusion:Among these five illness severity scores,CRIB has better predictive value for the mortality risk in ELBWI.NCIS,which is widely used in China,has relatively lower sensitivity and specificity,and needs to be further revised.