5种评分方法在脓毒症相关性脑病预后评估中的作用  

Effect of 5 methods of critical illness score in the prognosis evaluation of sepsis-associated encephalopathy

作　　者：陈奕豪 郭予雄 李旭锋 叶晓婷 张静雯 王春 胡燕 王静 吴家兴 郑贵浪 孙跃玉 邓医宇 卢奕云 Chen Yihao;Guo Yuxiong;Li Xufeng;Ye Xiaoting;Zhang Jingwen;Wang Chun;Hu Yan;Wang Jing;Wu Jiaxing;Zheng Guilang;Sun Yueyu;Deng Yiyu;Lu Yiyun(Guangdong Cardiovascular Institute,Guangzhou 510080,China;Department of Pediatric Intensive Care Unit,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Department of Intensive Care Unit,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)

机构地区：[1]广东省心血管病研究所,广州510080 [2]广东省人民医院(广东省医学科学院)儿科重症监护室,广州510080 [3]广东省人民医院(广东省医学科学院)重症医学科,广州510080

出　　处：《中华急诊医学杂志》2022年第4期520-527,共8页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金(82072230)。

摘　　要：目的探讨儿童危重病例评分(PCIS)、儿童第三代死亡风险评分(PRISMⅢ)、儿童器官障碍评分2(PELOD-2)、儿童序贯器官衰竭评分(p-SOFA)及格拉斯哥昏迷评分(GCS)在SAE预后评估中的作用。方法回顾性分析2010年1月至2020年12月广东省人民医院儿科重症监护室(PICU)收治的82例脓毒症相关性脑病(SAE)患儿的临床信息,依据住院28 d结局分为存活组和死亡组,采用ROC曲线下面积(AUC)评价PCIS、PRISMⅢ、PELOD-2、p-SOFA和GCS评分对SAE的死亡预测作用;Hosmer-Lemeshow拟合优度检验评估各评分方法校准度。结果82例SAE截至入院28 d,存活72例,死亡10例,病死率12.20%,死亡组GCS[7(3,12)分vs.12(8,14)分]、PCIS[76(64,82)分vs.82(78,88)分]评分低于存活组,PRISMⅢ[14(12,17)分vs.7(3,12)分]、PELOD-2[8(5,13)分vs.4(2,7)分],p-SOFA评分[11(5,12)分vs.6(3,9)分]高于存活组(P均<0.05)。PCIS、PRISMⅢ、PELOD-2、pSOFA和GCS评分预测SAE预后的AUC分别为0.773(P=0.012,AUC>0.7),0.832(P=0.02,AUC>0.7),0.767(P=0.014,AUC>0.7),0.688(P=0.084,AUC<0.7),0.692(P=0.077,AUC<0.7);拟合优度检验示PCIS(χ^(2)=5.329,P=0.722),PRISMⅢ(χ^(2)=12.877,P=0.177)、PELOD-2(χ^(2)=8.487,P=0.205)、pSOFA(χ^(2)=9.048,P=0.338)、GCS(χ^(2)=3.78,P=0.848)。结论PCIS、PRISMⅢ和PELOD-2评分对儿童SAE预后具有良好预测能力,其中PCIS评分可以更为准确地对SAE预后预测的拟合效果进行评估。Objective To explore the effect of pediatric critical illness score(PCIS),pediatric risk of mortalityⅢscore(PRISMⅢ),pediatric logistic organ dysfunction 2(PELOD-2),pediatric sequential organ failure assessment(p-SOFA)score and Glasglow coma scale(GCS)in the prognosis evaluation of septic-associated encephalopathy(SAE).Methods The data of children with SAE admitted to the Pediatric Intensive Care Unit(PICU),Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences from January 2010 to December 2020 were retrospectively analyzed.They were divided into the survival and death groups according to the clinical outcome on the 28th day after admission.The efficiency of PCIS,PRISMⅢ,PELOD-2,p-SOFA and GCS scores for predicting death were evaluated by the area under the ROC curve(AUC).The Hosmer-Lemeshow goodness-of-fit test assessed the calibration of each scoring system.Results Up to 28 d after admission,72 of 82 children with SAE survived and 10 died,with a mortality rate of 12.20%.Compared with the survival group,the death group had significantly lower GCS[7(3,12)vs.12(8,14)]and PCIS scores[76(64,82)vs.82(78,88)],and significantly higher PRISMⅢ[14(12,17)vs.7(3,12)],PELOD-2[8(5,13)vs.4(2,7)]and p-SOFA scores[11(5,12)vs.6(3,9)](P<0.05).The AUCs of PCIS,PRISMⅢ,PELOD-2,p-SOFA and GCS scores for predicting SAE prognosis were 0.773(P=0.012,AUC>0.7),0.832(P=0.02,AUC>0.7),0.767(P=0.014,AUC>0.7),0.688(P=0.084,AUC<0.7),and 0.692(P=0.077,AUC<0.7),respectively.Hosmer-Lemeshow goodness-of-fit test showed that PCIS(χ^(2)=5.329,P=0.722)predicted the mortality and the actual mortality in the best fitting effect,while PRISMⅢ(χ^(2)=12.877,P=0.177),PELOD-2(χ^(2)=8.487,P=0.205),p-SOFA(χ^(2)=9.048,P=0.338)and GCS(χ^(2)=3.780,P=0.848)had poor fitting effect.Conclusions The PCIS,PRISMⅢand PELOD-2 scores have good predictive ability assessing the prognosis of children with SAE,while the PCIS score can more accurately evaluate the fitting effect of SAE prognosis prediction.

关 键 词：危重评分方法 脓毒症相关性脑病 预后评估 儿童 

分 类 号：R720.597[医药卫生—急诊医学]