Mahieu Ludo M, De Dooy Jozef J, Cossey Veerle R, Goossens Linde L, Vrancken Sabine L, Jespers Ann Y, Vandeputte Christina T, De Muynck Aimé O
Department of Pediatrics, Division of Neonatology, University Hospital of Antwerp, Antwerp, Belgium.
Crit Care Med. 2002 Jul;30(7):1459-66. doi: 10.1097/00003246-200207000-00010.
To evaluate the performance of a scoring system (NOSEP) to predict nosocomial sepsis in neonates at the hospital where the score was developed (internal validation) and in an independent data set from other centers (external validation).
Multiple center prospective cohort study.
Six neonatal intensive care units from the Flanders in Belgium.
We analyzed two groups of patients: 62 episodes of presumed nosocomial sepsis in the internal validation cohort and 93 episodes of presumed nosocomial sepsis in a multiple center external validation cohort.
Assessment of the predictive power of the NOSEP score 24 hrs preceding sepsis workup and the patients' basic demographic characteristics and co-morbidity was performed. Diagnosis of nosocomial sepsis and the microbiology results were registered.
The NOSEP score's discriminative capability was very good in the internal validation (area under receiver operating characteristic curve = 0.73 +/- 0.08 [sem]). The NOSEP score performed satisfactory in the external validation (area under receiver operating characteristic curve = 0.66 +/- 0.06). The calibration capability in both validation sets as measured by goodness-of-fit tests (internal validation, p =.56; external validation, p =.48) was good. An improvement of the NOSEP score was obtained for the external centers by redefining the cut-off of the items of the NOSEP score (area under receiver operating characteristic curve for NOSEP-NEW-I = 0.71 +/- 0.05) or adding co-morbidity factors (area under receiver operating characteristic curve for NOSEP-NEW-II = 0.82 +/- 0.04), with good calibration performance (goodness-of-fit test, p >.50). Finally, the fit of the NOSEP score demonstrated no significant variation across subgroups of patients.
The predictive power of the original NOSEP score is very good in neonates at the original neonatal intensive care unit. In other neonatal intensive care units, its discriminatory performance is satisfactory but could be improved after modification of the variables in the model or adding additional variables. To use such a NOSEP score in other neonatal intensive care units, its accuracy has to be validated and adjusted if necessary.
评估一种评分系统（NOSEP）在其开发所在医院预测新生儿医院感染性脓毒症的性能（内部验证），以及在来自其他中心的独立数据集中的性能（外部验证）。
多中心前瞻性队列研究。
比利时弗拉芒地区的六个新生儿重症监护病房。
我们分析了两组患者：内部验证队列中有62例疑似医院感染性脓毒症发作，多中心外部验证队列中有93例疑似医院感染性脓毒症发作。
在脓毒症检查前24小时评估NOSEP评分的预测能力以及患者的基本人口统计学特征和合并症。记录医院感染性脓毒症的诊断和微生物学结果。
NOSEP评分在内部验证中的鉴别能力非常好（受试者操作特征曲线下面积 = 0.73 ± 0.08 [标准误]）。NOSEP评分在外部验证中的表现令人满意（受试者操作特征曲线下面积 = 0.66 ± 0.06）。通过拟合优度检验测量的两个验证集的校准能力良好（内部验证，p = 0.56；外部验证，p = 0.48）。通过重新定义NOSEP评分项目的临界值（NOSEP-NEW-I的受试者操作特征曲线下面积 = 0.71 ± 0.05）或添加合并症因素（NOSEP-NEW-II的受试者操作特征曲线下面积 = 0.82 ± 0.04），外部中心的NOSEP评分得到了改善，校准性能良好（拟合优度检验，p > 0.50）。最后，NOSEP评分在各患者亚组中的拟合情况无显著差异。
原始NOSEP评分在原新生儿重症监护病房的新生儿中预测能力非常好。在其他新生儿重症监护病房，其鉴别性能令人满意，但在对模型中的变量进行修改或添加其他变量后可得到改善。要在其他新生儿重症监护病房使用这样的NOSEP评分，必须对其准确性进行验证，并在必要时进行调整。
