Meyer Sascha, Gottschling Sven, Biran Tamir, Georg Thomas, Ehlayil Karim, Graf Norbert, Gortner Ludwig
Paediatric Intensive Care Unit, Department of Paediatrics, University Hospital of Saarland, Kirrbergerstrasse, 66421 Homburg, Germany.
Eur J Pediatr. 2005 Sep;164(9):563-7. doi: 10.1007/s00431-005-1695-y. Epub 2005 May 24.
Intensive front-line protocols have improved survival in children with malignancies; however, intensive multimodal therapy of paediatric malignancies can be associated with a significant risk of serious adverse events. Common risk scores (PRISM, PRISM III, APACHE-II) fail to predict mortality in these patients. A retrospective chart analysis of 32 paediatric cancer patients admitted to the Paediatric Intensive Care Unit (PICU) at the University Hospital of Saarland between January 2001 and December 2003 for life-threatening complications was performed. The aim of this study was to assess risk factors for short-term outcome (survival vs. non-survival when leaving the PICU) and to develop a risk score to estimate outcome in these patients. Overall survival was good (25 of 32 patients). Mortality rate was significantly related to leukaemia/lymphoma ( P = 0.029), to the number of organ failures ( P < 0.0001), neutropenia ( P = 0.001), septic shock ( P = 0.025), mechanical ventilation ( P = 0.01) and inotropic support ( P = 0.01). Employing multiple logistic regression, the strongest predictor for poor outcome was the number of organ failures ( P < 0.05). A risk score (cut-off value: >3 points for non-survival) which included the following risk factors (non-solid tumour, number of organ failures ( n > 2), neutropenia, septic shock, mechanical ventilation, and inotropic medication) yielded a sensitivity of 7/7 (95% CI: 4.56-7.00), a specificity of 23/25 (95% CI: 18.49-24.75), a positive predictive value of 23/23 (95% CI: 19.80-23.00), and a negative predictive value of 7/9 (95% CI: 3.60-8.74) for the time of admission to the PICU.
Although our risk of mortality score is of prognostic value in assessing short-term outcome in these patients, prospective validation in a larger study cohort is mandatory. Furthermore, it must be emphasised that this risk score must not be used for decision-making in an individual patient.
强化一线治疗方案提高了恶性肿瘤患儿的生存率；然而，小儿恶性肿瘤的强化多模式治疗可能会带来严重不良事件的重大风险。常用的风险评分（PRISM、PRISM III、APACHE-II）无法预测这些患者的死亡率。对2001年1月至2003年12月间因危及生命的并发症入住萨尔兰大学医院儿科重症监护病房（PICU）的32例儿科癌症患者进行了回顾性病历分析。本研究的目的是评估短期预后（离开PICU时的生存与非生存）的风险因素，并制定一个风险评分来估计这些患者的预后。总体生存率良好（32例患者中有25例）。死亡率与白血病/淋巴瘤（P = 0.029）、器官衰竭数量（P < 0.0001）、中性粒细胞减少（P = 0.001）、感染性休克（P = 0.025）、机械通气（P = 0.01）和血管活性药物支持（P = 0.01）显著相关。采用多因素逻辑回归分析，预后不良的最强预测因素是器官衰竭数量（P < 0.05）。一个风险评分（临界值：非生存>3分），包括以下风险因素（非实体瘤、器官衰竭数量（n>2）、中性粒细胞减少、感染性休克、机械通气和血管活性药物治疗），在入住PICU时的敏感性为7/7（95%CI：4.56 - 7.00），特异性为23/25（95%CI：18.49 - 24.75），阳性预测值为23/23（95%CI：19.80 - 23.00），阴性预测值为7/9（95%CI：3.60 - 8.74）。
虽然我们的死亡风险评分在评估这些患者的短期预后方面具有预后价值，但必须在更大的研究队列中进行前瞻性验证。此外，必须强调的是，这个风险评分不能用于个体患者的决策。
