PCIS联合NT-pro-BNP评估儿童重症监护室CRRT患儿预后的价值分析

Value of PCIS Combined NT-pro-BNP on Evaluating the Prognosis of Children with CRRT in Pediatric Intensive Care Unit

目的研究小儿危重病例评分(pediatric critical illness score,PCIS)和血清N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-pro-BNP)评估儿童重症监护室(pediatric intensive care unit,PICU)连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)患儿预后的临床价值。方法选取2019-10/2022-03月于作者医院PICU行CRRT的192例重症患儿为研究对象,在治疗前进行PCIS,检测血清NT-pro-BNP水平并随访预后情况。根据随访结果将患儿分为生存组和死亡组,并分析其影响因素,探讨PCIS和血清NT-pro-BNP水平预测患儿死亡的临床价值。结果192例患者经CRRT后死亡34例。死亡组基础疾病中脓毒症占比明显高于生存组(P<0.05);死亡组血pH值、动脉血氧分压(partial arterial oxygenation pressure,PaO)、血钠和PCIS低于生存组,肌酐/尿素氮(creatinine/blood urea nitrogen,Cr/BUN)和血清NT-pro-BNP水平高于生存组,差异均有统计学意义(P均<0.05)。多因素Logistic回归分析显示,脓毒症、血pH值、Cr/BUN及血清NT-pro-BNP水平是影响CRRT治疗PICU患儿预后的独立危险因素(P<0.05);受试者工作特征(receiver operating characteristic curve,ROC)曲线分析结果显示,PCIS和血清NT-pro-BNP水平预测PICU患儿CRRT治疗后死亡的曲线下面积(area under the curve,AUC)分别为0.860和0.834,灵敏度分别为70.59%和76.47%,特异度分别为89.87%和86.08%;二者联合预测灵敏度为85.29%,特异度为83.54%,准确度为83.85%。结论PCIS和血清NT-pro-BNP水平与CRRT治疗PICU患儿预后存在密切联系,对预测患儿死亡均具有良好参考价值,且二者联合可提升预测准确度,为预后评估和合理干预提供参考信息。

Objective To study the clinical value of pediatric critical illness score(PCIS)and serum N-terminal pro-brain natriuretic peptide(NT-pro-BNP)on evaluating the prognosis of children with continuous renal replacement therapy(CRRT)in pediatric intensive care unit(PICU).Methods A total of 192 critically ill children who underwent CRRT in PICU of author′s hospital from October 2019 to March 2022 were selected.The PCIS was performed before treatment,and the level of serum NT-pro-BNP was detected and the prognosis was followed up.The children were divided into survival group and death group according to the follow-up results,and the influencing factors were analyzed.The clinical value of PCIS and serum NT-pro-BNP level on predicting death of children was explored.Results Among the 192 patients,34 cases died after CRRT.The proportion of sepsis in underlying diseases in death group was significantly higher than that in survival group(P<0.05).The blood pH value,partial arterial oxygenation pressure(PaO),blood sodium and PCIS in death group were lower while the creatinine/blood urea nitrogen(Cr/BUN)and serum NT-pro-BNP were higher than survival group,and the differences were statistically significant(all P<0.05).Multivariate Logistic regression analysis showed that sepsis,blood pH value,Cr/BUN and serum NT-pro-BNP level were independent risk factors for the prognosis of PICU children treated by CRRT(P<0.05).Receiver operating characteristic curve(ROC)showed that the area under the curve(AUC)values of PCIS and serum NT-pro-BNP in predicting the death of PICU children after CRRT were 0.860 and 0.834,with sensitivities of 70.59% and 76.47%,specificities of 89.87% and 86.08% respectively.The sensitivity,specificity and accuracy of combined prediction of the two were 85.29%,83.54% and 83.85% respectively.Conclusion PCIS and serum NT-pro-BNP level are closely related to the prognosis of PICU children treated by CRRT,and have good reference value on predicting the death of children.In addition,the combination of the two can improve the prediction accuracy and provide reference information for prognosis assessment and reasonable intervention.