新生儿序贯器官衰竭评估评分对极低/超低出生体重儿晚发型败血症死亡风险预测价值

Predictive value of neonatal sequential organ failure assessment score for mortality risk of late-onset sepsis in very/extremely low birth weight infants

目的 探索新生儿序贯器官衰竭评估(nSOFA)评分对极低/超低出生体重儿晚发型败血症死亡风险的预测价值。方法 回顾性分析2017年1月至2021年12月收治的诊断为晚发型败血症的极低/超低出生体重儿的临床资料。在败血症确诊前后的5个时间点(T-24、T-12、T0、T12、T24)计算nSOFA评分,利用受试者工作特征(ROC)曲线分析nSOFA评分对患儿死亡风险的预测价值。结果 纳入患儿135例,男66例、女69例,败血症诊断年龄为21.0(13.5~25.0)d。113例患儿存活,死亡22例(病死率16.3%)。存活组与死亡组之间在T-12、T0、T12、T24时间点nSOFA评分差异均有统计学意义(P<0.05)。ROC曲线分析显示,T-12、T 0、T 12、T 24时间点nSOFA评分预测极低/超低出生体重儿晚发型败血症死亡风险的灵敏度分别为59.1%、81.8%、93.2%、98.3%,特异度分别为63.6%、71.7%、73.7%、89.9%,曲线下面积分别为0.64、0.79、0.89、0.95。T 24时nSOFA评分的灵敏度、特异度、曲线下面积均最大。结论 nSOFA评分对极低/超低出生体重儿晚发型败血症死亡风险具有预测价值,nSOFA评分越高,败血症患儿死亡风险越大。

Objective To explore the predictive value of neonatal sequential organ failure assessment(nSOFA)score for the death risk of late-onset sepsis in very/extremely low birth weight infants.Methods The clinical data of very/extremely low birth weight infants diagnosed with late-onset sepsis admitted from January 2017 to December 2021 were retrospectively analyzed.The nSOFA score was calculated at 5 time points(T-24,T-12,T0,T12,T24) before and after the diagnosis of sepsis.Receiver operating characteristic(ROC) curve was used to analyze the predictive value of nSOFA score for mortality risk of children.Results A total of 135 children(66 boys and 69 girls) were included,and the age at diagnosis of sepsis was 21.0( 13.5-25.0) days.One hundred and thirteen children survived and 22 died(case fatality rate 16.3%).There were statistically significant differences in nSOFA scores between survival group and death group at T-12,T0,T12 and T24 time points(P<0.05).ROC curve analysis showed that the sensitivity of nSOFA score at T-12,T0,T12and T24 to predict the death risk of late-onset sepsis in very/extremely low birth weight infants was 59.1%,81.8%,93.2%and 98.3%,and the specificity was 63.6%,71.7%,73.7% and 89.9%,respectively.The areas under the curve were 0.64,0.79,0.89 and 0.95,respectively.The sensitivity,specificity and area under the curve of nSOFA score were the largest at T 24.Conclusions The nSOFA score has a predictive value for the risk of death from late-onset sepsis in very/extremely low birth weight infants.The higher the nSOFA score,the greater the risk of death from sepsis.