NT-proBNP对有创机械通气小儿急性呼吸衰竭28 d内死亡的预测价值研究

Study on the predictive value of NT-proBNP for death within 28 days of acute respiratory failure in children requiring invasive mechanical ventilation

目的:研究氧合指数(OI)和N末端B型钠尿肽前体(NT-proBNP)在儿童重症监护病房(PICU)需要有创机械通气的急性呼吸衰竭(ARF)患儿28 d内死亡的预测价值。方法:选取2017—2019年入住本院PICU的需要有创机械通气的111例ARF患儿,收集并分析患儿临床资料,包括儿童机械通气死亡风险评分Ⅲ(PRISMⅢ)、OI、NT-proBNP、机械通气后28 d内生存情况等。采用单因素和多因素logistic回归分析评估ARF患儿28 d内死亡的危险因素。采用受试者工作特征(ROC)曲线评估NT-proBNP、OI和年龄预测28 d生存情况的效果。结果:患儿中位年龄12个月(4.5~66个月),28 d内79例存活(71.17%),32例死亡(28.83%)。与存活组相比,死亡组OI显著升高,NT-proBNP水平显著降低(均P<0.05),两组24 h内PRISMⅢ评分无显著差异(P>0.05)。多因素logistic回归分析结果显示,年龄、OI、NT-proBNP均为ARF患儿28 d内死亡的独立危险因素(P<0.05)。年龄、OI、NT-proBNP及三者联合的ROC曲线下面积(AUC)分别为0.625 0、0.603 6、0.602 8和0.657 2,年龄+OI+NT-proBNP联合具有更好的预测效果。结论:在ARF需机械通气患儿中,最初24 h的年龄、OI和NT-proBNP水平与28 d死亡风险相关;年龄、OI和NT-proBNP三者联合有助于早期识别ARF插管患儿死亡风险。

Objective:To explore the predictive value of oxygenation index(OI) and N-terminal pro-B-type natriuretic peptide(NT-proBNP) within 28 days of death in pediatric intensive care unit(PICU) patients with acute respiratory failure(ARF) requiring invasive mechanical ventilation.Methods:Clinical data of 111 children with ARF who were admitted to PICU in the First Affiliated Hospital of Guangxi Medical University and required invasive mechanical ventilation from 2017 to 2019 were collected and analyzed,including the Pediatric Risk of Mortality Ⅲ scores(PRISM Ⅲ),OI,NT-proBNP,and survival within 28 days after mechanical ventilation.Univariate and multivariable logistic regression analysis were used to assess the risk factors for death within 28 days in children with ARF.Receiver operating characteristic(ROC) curves were drawn to evaluate the effect of NT-proBNP,OI,and age in predicting 28-day survival.Results:The median age was 12 months(4.5-66 months),with 79 survivors(71.17%) and 32 non-survivors(28.83%) within 28 days.OI was significantly higher,while NT-proBNP was significantly lower in the non-survivor group compared with the survivor group(both P<0.05),and there was no difference in the PRISM Ⅲ between the two groups within 24 h(P>0.05).Multivariate logistic regression analysis showed that age,OI and NT-proBNP were independent risk factors for death in children with ARF within 28 days(P<0.05).The area under ROC curve(AUC) of age,OI,NT-proBNP and their combination were 0.6250,0.6036,0.6028 and 0.6572,respectively.The combination of age+OI+NT-proBNP had a better prediction effect.Conclusion:In children with ARF requiring mechanical ventilation,age,OI and NT-proBNP levels in the first 24 hours are associated with 28-day mortality risk.The combination of age,OI,and NT-proBNP is helpful for early identification of mortality risk in intubated children with ARF.