不同方法对中国西南地区儿童重症监护病房脓毒症病死率的预测价值  

Different methods in predicting mortality of pediatric intensive care units sepsis in Southwest China

作　　者：刘蓉 于智彩 肖长雪 肖曙芳[2] 何娟[2] 石艳[3] 花媛媛 周继敏[3] 张国英 王涛 姜建渝 熊道学 陈艳 徐洪波 云虹 孙慧 潘婷婷 王瑞 朱双妹 黄栋[9] 刘禹江 胡宇航 任新蕊 石明芳[11] 宋思尊 罗菊梅[11] 刘娟 张娟 许峰[1] Liu Rong;Yu Zhicai;Xiao Changxue;Xiao Shufang;He Juan;Shi Yan;Hua Yuanyuan;Zhou Jimin;Zhang Guoying;Wang Tao;Jiang Jianyu;Xiong Daoxue;Chen Yan;Xu Hongbo;Yun Hong;Sun Hui;Pan Tingting;Wang Rui;Zhu Shuangmei;Huang Dong;Liu Yujiang;Hu Yuhang;Ren Xinrui;Shi Mingfang;Song Sizun;Luo Jumei;Liu Juan;Zhang Juan;Xu Feng(Department of Pediatric Critical Care,Children′s Hospital of Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases,Chongqing 400014,China;Department of Pediatric Critical Care,Kunming Children′s Hospital,Kunming 650103,China;Department of Pediatric Critical Care,the First People′s Hospital of Liangshan Yi Autonomous Prefecture,Xichang 615099,China;Department of Pediatric Critical Care,Chengdu Women′s and Children′s Central Hospital,Chengdu 610073,China;Department of Pediatric Critical Care,Chongqing University Three Gorges Hospital,Chongqing 400030,China;Department of Pediatric Critical Care,Guizhou Provincial Children′s Hospital,Zunyi 563099,China;Department of Pediatric Critical Care,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China;Department of Pediatric Critical Care,Yuxi Children′s Hospital,Yuxi 653199,China;Department of Pediatric Critical Care,Guizhou Provincial People′s Hospital,Guiyang 550499,China;Department of Pediatric Critical Care,Sichuan Provincial Maternity and Child Health Hospital,Chengdu 610045,China;Department of Pediatric Critical Care,the First People′s Hospital of Yibin,Yibin 644099,China;Department of Pediatric Critical Care,Nanchong Central Hospital,Nanchong 637003,China)

机构地区：[1]重庆医科大学附属儿童医院重症医学科、国家儿童健康与疾病临床医学研究中心、儿童发育疾病研究教育部重点实验室、儿童代谢与炎症性疾病重庆市重点实验室,重庆400014 [2]昆明市儿童医院重症医学科,昆明650103 [3]四川省凉山彝族自治州第一人民医院儿童重症医学科,西昌615099 [4]成都市妇女儿童中心医院儿童重症医学科,成都610073 [5]重庆大学附属三峡医院儿童重症医学科,重庆400030 [6]贵州省儿童医院重症医学科,遵义563099 [7]贵州医科大学附属医院儿童重症医学科,贵阳550004 [8]玉溪市儿童医院重症医学科,玉溪653199 [9]贵州省人民医院儿童重症医学科,贵阳550499 [10]四川省妇幼保健院儿童重症医学科,成都610045 [11]宜宾市第一人民医院儿童重症医学科,宜宾644099 [12]南充市中心医院儿童重症医学科,南充637003

出　　处：《中华儿科杂志》2024年第3期204-210,共7页Chinese Journal of Pediatrics

基　　金：国家儿童健康与疾病临床医学研究中心2021年度临床医学研究重点项目(NCRCCHD-2021-KP-03);重庆英才计划(cstc2022ycjh-bgzxm0271)。

摘　　要：目的评估全身炎症反应综合征(SIRS)标准、儿童序贯器官衰竭评分(pSOFA)和小儿危重病例评分(PCIS)对中国西南地区儿童重症监护病房(PICU)中儿童脓毒症病死率的预测价值。方法前瞻性多中心观察性研究。以2022年4月至2023年3月收入中国西南地区12个PICU诊断为脓毒症的447例患儿为研究对象。根据出PICU时转归分为存活组和死亡组,在患儿入PICU 24 h内记录SIRS、pSOFA和PCIS的相关生理学参数并评分,比较一般临床资料和部分实验室检查结果。使用受试者工作特征曲线曲线下面积(AUC)比较SIRS标准、pSOFA和PCIS对儿童脓毒症病死率的预测价值。结果447例脓毒症患儿男260例、女187例,年龄2.5(0.8,7.0)岁。存活组405例,死亡组42例。418例(93.5%)符合儿童SIRS标准,440例(98.4%)符合pSOFA≥2分标准。符合SIRS标准的条目数量在存活组和死亡组之间差异无统计学意义[3(2,4)比3(3,4)分,Z=1.30,P=0.192];死亡组的pSOFA分数显著高于存活组[9(6,12)比4(3,7)分,Z=6.56,P<0.001],PCIS评分显著低于存活组[72(68,81)比82(76,88)分,Z=5.90,P<0.001]。pSOFA(AUC=0.82)和PCIS(AUC=0.78)对脓毒症病死率的预测价值均显著高于SIRS标准(AUC=0.56)(Z=6.59、4.23,均P<0.001);pSOFA与PCIS比较差异无统计学意义(Z=1.35,P=0.176)。血小板计数、降钙素原、血乳酸、白蛋白、肌酐、总胆红素、活化部分凝血活酶时间、凝血酶原时间和国际标准化比值对脓毒症病死率也均有一定的预测价值(AUC=0.64、0.68、0.80、0.64、0.68、0.60、0.77、0.75、0.76,均P<0.05)。结论与SIRS相比,pSOFA和PCIS在PICU儿童脓毒症病死率方面均具有较好的预测价值。Objective To investigate the value of systemic inflammatory response syndrome(SIRS),pediatric sequential organ failure assessment(pSOFA)and pediatric critical illness score(PCIS)in predicting mortality of pediatric sepsis in pediatric intensive care units(PICU)from Southwest China.Methods This was a prospective multicenter observational study.A total of 447 children with sepsis admitted to 12 PICU in Southwest China from April 2022 to March 2023 were enrolled.Based on the prognosis,the patients were divided into survival group and non-survival group.The physiological parameters of SIRS,pSOFA and PCIS were recorded and scored within 24 h after PICU admission.The general clinical data and some laboratory results were recorded.The area under the curve(AUC)of the receiver operating characteristic curve was used to compare the predictive value of SIRS,pSOFA and PCIS in mortality of pediatric sepsis.Results Amongst 447 children with sepsis,260 patients were male and 187 patients were female,aged 2.5(0.8,7.0)years,405 patients were in the survival group and 42 patients were in the non-survival group.418 patients(93.5%)met the criteria of SIRS,and 440 patients(98.4%)met the criteria of pSOFA≥2.There was no significant difference in the number of items meeting the SIRS criteria between the survival group and the non-survival group(3(2,4)vs.3(3,4)points,Z=1.30,P=0.192).The pSOFA score of the non-survival group was significantly higher than that of the survival group(9(6,12)vs.4(3,7)points,Z=6.56,P<0.001),and the PCIS score was significantly lower than that of the survival group(72(68,81)vs.82(76,88)points,Z=5.90,P<0.001).The predictive value of pSOFA(AUC=0.82)and PCIS(AUC=0.78)for sepsis mortality was significantly higher than that of SIRS(AUC=0.56)(Z=6.59,4.23,both P<0.001).There was no significant difference between pSOFA and PCIS(Z=1.35,P=0.176).Platelet count,procalcitonin,lactic acid,albumin,creatinine,total bilirubin,activated partial thromboplastin time,prothrombin time and international normalized ratio were all

关 键 词：脓毒症 重症监护病房 儿科 预测 

分 类 号：R720.597[医药卫生—急诊医学]