儿童死亡风险评分在重症手足口病的应用  

The performance of pediatric risk of mortality score in pediatric patients with severe hand, foot and mouth disease

作　　者：罗兰[1] 隆彩霞[1] 陈鹏[1] 卢秀兰[1] 肖政辉[1] 刘潇[1] 左超[1] 仇君[1] 

机构地区：[1]湖南省儿童医院急救中心儿童脓毒症研究中心,长沙410007

出　　处：《中国小儿急救医学》2015年第8期567-570,共4页Chinese Pediatric Emergency Medicine

基　　金：十二五国家科技支撑项目（2012BA104802）

摘　　要：目的应用儿童死亡风险评分（pediatric risk of mortality score，PRISM）评估重症手足口病患儿的病情严重程度，探讨PRISM对重症手足口病患儿并发肺出血及死亡风险的预测能力。方法选取于2010年1月至2013年6月入住我院重症监护室的符合重症手足口病诊断标准的424例患儿。收集PRISM的相关生理参数及结局资料，通过受试者工作特征曲线（receiver operating characteristic，Roc）下的面积来评估PRISM对肺出血及死亡和存活的分辨力，Hosmer-Lemeshow拟合优度检验来评估预期病死率和实际病死率是否拟合。结果PRISM分辨是否发生肺出血的ROC曲线下面积为0．87（95％CI：0．80-0．94），PRISM分辨是否发生死亡的ROC曲线下面积0．87（95％CI：0．80～0．95）；通过Hosmer—Lemeshow拟合优度检验来评价模型的准确度发现：PRISM预测肺出血发生人数和实际发生人数存在差异（r=36．66，P〈0．001）；PRISM预测死亡人数和实际死亡人数存在差异（r=41．11，P〈0．001）。结论PRISM对重症手足口病患儿合并肺出血及死亡风险评估具有较好的分辨力，但是拟合性欠佳。Objective To comment the severity of severe hand, foot and mouth disease（HFMD） by pediatric risk of mortality score （ PRISM）, and assess the performance of PRISM in predicting mortality or complication probability in HFMD. Methods Four hundred and twenty-four severe HFMD pediatric patients were recruited in the study from lth Jan 2010 to 31th June 2013. Information on the outcome and the variables required to calculate PRISM score were collected. The logistic regression model developed in the learning sample was evaluated in the test sample by calculating the area under the receiver operating characteristic （ROC） curve to assess discrimination pneumorrhagia and death. Calibration across deciles of risk was evalua- ted using the Hosmer-Lemeshow goodness-of-fitx2 test. Results The area under the ROC curve were 0. 87 （95 % CI 0. 80 - 0.94 ） for PRISM in predicting pneumorrhagia probability. The area under the ROC curve were 0. 87 （95% CI 0. 80 -0. 95） for PRISM in predicting mortality probability. The PRISM in observed and expected pneumorrhagia did not demonstrate good calibration at ten mortality risk intervals （X^2 = 36. 66, P 〈 0. 001 ）. The PRISM in observed and expected mortality did not demonstrate good calibration at ten mortali- ty risk intervals （X^2 = 41.11,P 〈 0. 001 ）. Conclusion The PRISM score is demonstrated good discrimination of pneumorrhagia and death in HFMD pediatric patients,but the performance of calibration is not good.

关 键 词：儿童死亡风险评分 重症手足口病 受试者工作特征曲线 Hosmer—Lemeshow拟合优度检验 

分 类 号：R725.1[医药卫生—儿科]