4种小儿危重死亡评分对危重患儿死亡风险的预测价值  

Predictive value of four pediatric scores of critical illness and mortality on evaluating mortality risk in pediatric critical patients

作　　者：张丽丹[1] 黄慧敏[1] 程玉才[1] 徐玲玲[1] 黄雪琼[1] 裴瑜馨[1] 唐雯[1] 覃肇源[2] 

机构地区：[1]中山大学附属第一医院儿科ICU,广东广州510080 [2]中山大学附属第一医院儿科,广东广州510080

出　　处：《中华危重病急救医学》2018年第1期51-56,共6页Chinese Critical Care Medicine

基　　金：国家临床重点专科建设项目（2011-872）;广东省科技计划项目（20138021800276）;广东省广州市科技计划项目（201510010148）

摘　　要：目的 探讨小儿危重病例评分（PCIS）、儿童死亡风险评分Ⅲ（PRISMⅢ）、儿童器官功能障碍评分2（PELOD-2）、儿童多器官功能障碍评分（P-MODS）对危重患儿死亡风险的预测价值.方法 回顾性分析2012年8月至2017年5月入住中山大学附属第一医院儿童重症加强治疗病房（PICU）的461例危重患儿的临床资料,收集所有患儿的性别、年龄、基础疾病、PICU住院时间;根据住院期间临床结局将患儿分为存活组和死亡组.记录两组患儿入PICU后24 h内PCIS、PRISMⅢ、PELOD-2、P-MODS相关生理学参数并评分;绘制受试者工作特征曲线（ROC）,采用ROC曲线下面积（AUC）评估PCIS、PRISMⅢ、PELOD-2、P-MODS对死亡的预测能力;采用Hosmer-Lemeshow拟合优度检验,评估各项评分系统预测病死率与实际病死率的拟合度.结果 461例危重患儿中35例因资料严重缺失、住院未超过24 h、入院8 h内死亡而被排除,最终426例患儿纳入分析;住院期间存活355例,死亡71例,病死率16.7%.两组患儿性别、年龄、基础疾病及PICU住院时间比较差异无统计学意义;死亡组PCIS评分明显低于存活组〔分：80（76,88）比86（80,92）〕,PRISMⅢ、PELOD-2及P-MODS评分均明显高于存活组〔PRISMⅢ（分）：16（13,22）比12（10,15）,PELOD-2（分）：6（5,9）比4（2,5）,P-MODS（分）：6（4,9）比3（2,6）,均P〈0.01〕.ROC曲线分析显示,PCIS、PRISMⅢ、PELOD-2和P-MODS评分预测危重患儿死亡的AUC分别为0.649、0.731、0.773、0.747.Hosmer-Lemeshow拟合优度检验结果显示,PCIS预测病死率与实际病死率的拟合效果最好（χ2=7.573,P=0.476）;PELOD-2、P-MODS预测病死率与实际病死率的拟合效果尚可（χ12=9.551,P1=0.145;χ22=10.343,P2=0.111）;而PRISMⅢ预测病死率与实际病死率拟合效果不佳（χ2=43.549,P〈0.001）.结论 PRISMⅢ、PELOD-2、P-MODS均可较好预测危重患儿的预后,准确评估病情;PCIS的预测病死率与实际病� Objective To assess the performance of pediatric clinical illness score （PCIS）, pediatric risk of mortality scoreⅢ（PRISMⅢ）, pediatric logistic organ dysfunction score 2 （PELOD-2）, and pediatric multiple organ dysfunction score （P-MODS） in predicting mortality in critically ill pediatric patients. Methods The data of critically ill pediatric patients admitted to Pediatric Intensive Care Unit （PICU） of First Affiliated Hospital of Sun Yat-Sen University from August 2012 to May 2017 were retrospectively analyzed. The gender, age, basic diseases, the length of PICU stay were collected. The children were divided into survival group and non-survival group according to the clinical outcome during hospitalization. The variables of PCIS, PRISMⅢ, PELOD-2, and P-MODS were collected and scored. Receiver operating characteristic （ROC） curve was plotted, the efficiency of PCIS, PRISMⅢ, PELOD-2, and P-MODS for predicting death were evaluated by the area under ROC curve （AUC）. Hosmer-Lemeshow goodness of fit test was used to evaluate the fitting degree of each scoring system to predict the mortality and the actual mortality. Results Of 461 critically ill children, 35 children were excluded because of serious data loss, hospital stay not exceeding 24 hours, and death within 8 hours after admission. Finally, a total of 426 pediatric patients were enrolled in this study. 355 pediatric patients were survived, while 71 were not survived during hospitalization, with the mortality of 16.7%. There was no significant difference in gender, age, underlying diseases or length of PICU stay between the two groups. PCIS score in non-survival group was significantly lower than that of survival group [80 （76, 88） vs. 86 （80, 92）], and PRISMⅢ, PELOD-2 and P-MODS scores were significantly increased [PRISMⅢ： 16 （13, 22） vs. 12 （10, 15）, PELOD-2： 6 （5, 9） vs. 4 （2, 5）, P-MODS： 6 （4, 9） vs. 3 （2, 6）, all P 〈 0.01]. ROC curve analysis showed that the AUCs of PCIS, PR

关 键 词：危重评分 死亡评分 预测 病死率 

分 类 号：R720.597[医药卫生—急诊医学]