四种重症评分系统对脓毒症患儿预后预测价值的比较  

Comparison of the predictive value of four critical scoring systems in predicting the prognosis ofchildrenwith sepsis

作　　者：李玉娜 王文珍 杨春凤[1] 李玉梅[1] Li Yuna;Wang Wenzhen;Yang Chunfeng;Li Yumei(Pediatric Intensive Care Unit,The First Hospital of Jilin University,Changchun 130021,China;Department of Pediatrics,Huashan Hospital of Fudan University,Shanghai 200040,China)

机构地区：[1]吉林大学第一医院儿童重症监护室,长春130021 [2]复旦大学附属华山医院儿内科,上海200040

出　　处：《中国小儿急救医学》2024年第3期200-205,共6页Chinese Pediatric Emergency Medicine

基　　金：吉林省科技厅项目(20210204134YY)。

摘　　要：目的分析儿童危重病例评分(PCIS)、儿童器官功能障碍评分2(PELOD-2)、儿童死亡风险评分Ⅲ(PRISMⅢ)、儿童序贯器官功能障碍评分(pSOFA)4种重症评分系统对脓毒症患儿疾病严重程度及预后的预测价值。方法回顾性分析2015年8月至2020年12月入住吉林大学第一医院儿童重症监护病房159例脓毒症患儿的病历资料。根据患儿入儿童重症监护病房后24 h内最差的生理指标计算PCIS评分、PELOD-2评分、PRISMⅢ评分及pSOFA评分。按照临床结局分为存活组和死亡组,按照脓毒症严重程度分为脓毒症(无脏器损伤)组和严重脓毒症组。利用受试者工作特征(ROC)曲线评价PCIS评分、PELOD-2评分、PRISMⅢ评分及pSOFA评分对脓毒症患儿疾病严重程度和预后的预测价值。结果存活组97例(61.01%),死亡组62例(38.99%);严重脓毒症组141例(88.68%)。PCIS、PELOD-2、PRISMⅢ、pSOFA评分预测脓毒症患儿发生严重脓毒症的ROC曲线下面积分别为0.869、0.875、0.672、0.933(均P<0.05);PCIS、PELOD-2、PRISMⅢ、pSOFA评分预测脓毒症患儿死亡风险的ROC曲线下面积分别为0.687、0.697、0.716、0.656(均P<0.05)。结论4种评分系统中,pSOFA评分对脓毒症患儿疾病的严重程度预测价值最高,PRISMⅢ评分预测脓毒症患儿死亡的价值更高。Objective To analyze the predictive value of four scoring systems,Pediatric Clinical Illness Score(PCIS),Pediatric Logistic Organ Dysfunction Score 2(PELOD-2),Pediatric Risk of MortalityⅢ(PRISMⅢ),and Pediatric Sequential Organ Failure Assessment(pSOFA),in the severity and prognosis in pediatric sepsis.Methods The medical records of 159 children with sepsis who admitted to PICU at the First Hospital of Jilin University between August 2015 and December 2020 were retrospectively analyzed.The PCIS,PELOD-2,PRISMⅢand pSOFA scores were calculated according to the worst value of each index within 24 h of admission.The children were divided into survival group and death group based on clinical outcomes during hospitalization.The children were stratified according to the severity of sepsis into sepsis(no organ dysfunction)group(n=18)and severe sepsis group(n=141).The receiver operator characteristic(ROC)curve was used to evaluate the value of PCIS,PELOD-2,PRISMⅢand pSOFA scores in predicting the severity and prognosis in pediatric sepsis.Results There were 97(61.01%)cases in the survival group and 62(38.99%)cases in the death group.There were 141(88.68%)children with severe sepsis.The areas under curve(AUCs)of PCIS,PELOD-2,PRISMⅢand pSOFA scores for predicting severe sepsis in children with sepsis were 0.869,0.875,0.672 and 0.933,respectively(all P<0.05).The AUCs of PCIS,PELOD-2,PRISMⅢand pSOFA scores for predicting the death of children with sepsis in PICU were 0.687,0.697,0.716 and 0.656,respectively(all P<0.05).Conclusion Among the four scoring systems,the pSOFA scoring system had the highest predictive power for the severity of sepsis.The PRISMⅢscore had higher value in assessing the risk of death in all patients with sepsis.

关 键 词：脓毒症 儿童 危重评分 预后 

分 类 号：R720.597[医药卫生—急诊医学]