García Sanz C, Rupérez Lucas M, López-Herce Cid J, Vigil Escribano D, Garrido Cantarero G
Sección de Cuidados Intensivos Pediátricos. Unidad de Investigación. Servicio de Medicina Preventiva y Gestión de Calidad. Hospital General Universitario Gregorio Marañón. Madrid. España.
An Esp Pediatr. 2002 Nov;57(5):394-400.
To analyze and compare the prognostic value of the pediatric index of mortality (PIM) score and lactate values on admission to a pediatric intensive care unit (PICU).
We performed a prospective study of 500 consecutive children: 237 girls (47.4 %) and 263 boys (52.6 %) with a mean age of 51.5 59.7 (range: 3 days-18 years) admitted to our PICU. PIM scores and blood lactate concentrations were determined on admission. The predictive ability of PIM and lactate concentrations in relation to mortality and length of stay in the PICU were analyzed.
Thirty-six patients (7.2 %) died. According to the PIM score, the mean probability of death in children who died was 23.6 % 28.9, which was significantly higher than that in surviving children (3.4 % 7.3; p < 0.001). The area under the ROC curve for PIM was 0.81 0.03 (95 % CI: 0.74-0.89). Lactate level in nonsurvivors was 4.9 % 3.5 mmol/L, which was significantly higher than that in survivors (1.9 % 1.5 mmol/L; p < 0.001). The area under the ROC curve for blood lactate was 0.76 0.04 (95 % CI: 0.67-0.85). No statistically significant differences were found between either ROC curves. In survivors, a significant relationship was found between PIM score and length of stay in the PICU while in nonsurvivors an inverse relationship was found between blood lactate concentrations and length of stay.
Both PIM score and blood lactate concentrations on admission to the PICU have a moderate prognostic value in critically-ill children. The prognostic value of the PIM score is greater than that of blood lactate concentration but is more difficult to obtain, whereas blood lactate determination is fast and easy.
分析并比较小儿死亡指数（PIM）评分及乳酸值对入住儿科重症监护病房（PICU）患儿的预后价值。
我们对500例连续入院患儿进行了一项前瞻性研究，其中包括237名女孩（47.4%）和263名男孩（52.6%），平均年龄为51.5±59.7岁（范围：3天至18岁），均入住我院PICU。入院时测定PIM评分及血乳酸浓度。分析PIM及乳酸浓度对死亡率和PICU住院时间的预测能力。
36例患者（7.2%）死亡。根据PIM评分，死亡患儿的平均死亡概率为23.6%±28.9%，显著高于存活患儿（3.4%±7.3%；p<0.001）。PIM的ROC曲线下面积为0.81±0.03（95%CI：0.74 - 0.89）。非存活者的乳酸水平为4.9±3.5 mmol/L，显著高于存活者（1.9±1.5 mmol/L；p<0.001）。血乳酸的ROC曲线下面积为0.76±0.04（95%CI：0.67 - 0.85）。两条ROC曲线之间未发现统计学显著差异。在存活者中，PIM评分与PICU住院时间之间存在显著关系，而在非存活者中，血乳酸浓度与住院时间呈负相关。
PICU入院时的PIM评分和血乳酸浓度对危重症患儿均具有中等预后价值。PIM评分的预后价值大于血乳酸浓度，但获取难度更大，而血乳酸测定快速简便。
