Bührer Christoph, Metze Boris, Obladen Michael
Department of Neonatology, Charité University Medical Center, Campus Virchow-Klinikum, Berlin, Germany.
Acta Paediatr. 2008 Jul;97(7):899-903. doi: 10.1111/j.1651-2227.2008.00793.x. Epub 2008 Apr 23.
The mortality risk of very low birth weight (VLBW) (<1500 g) infants has been estimated by the Clinical Risk Index for Babies (CRIB). Superior discriminatory power has been claimed for the revised CRIB-II score based on birth weight, gestational age, sex, temperature and base excess (BE) at admission. This analysis compared the power of CRIB, CRIB-II, birth weight and gestational age to predict death prior to discharge.
Of 1485 consecutive VLBW infants admitted between January 1, 1991 and December 31, 2006, who survived for >or=12 h, CRIB and CRIB-II calculations were possible in 1358 infants (92%). Predictive power of variables was assessed by comparing areas under receiver operator characteristics curves (AUC).
CRIB (AUC [95% confidence intervals] 0.82 [0.78-0.86]) performed significantly better than birth weight (0.74 [0.69-0.79]) or gestational age (0.71 [0.66-0.76]), while CRIB-II (0.69 [0.64-0.74]) was rather inferior to CRIB and did not differ significantly from birth weight or gestational age. No substantial changes were seen when substituting worst BE during the first 12 h of life for BE at admission when calculating CRIB-II.
CRIB-II does not result in improved estimation of mortality risk in VLBW infants as compared to CRIB, birth weight or gestational age.
极低出生体重(VLBW,<1500克)婴儿的死亡风险已通过婴儿临床风险指数(CRIB)进行评估。基于出生体重、胎龄、性别、体温和入院时碱剩余(BE)的修订CRIB-II评分被认为具有更强的鉴别能力。本分析比较了CRIB、CRIB-II、出生体重和胎龄预测出院前死亡的能力。
在1991年1月1日至2006年12月31日期间收治的1485例连续存活≥12小时的极低出生体重婴儿中,1358例(92%)婴儿可进行CRIB和CRIB-II计算。通过比较受试者操作特征曲线下面积(AUC)评估变量的预测能力。
CRIB(AUC[95%置信区间]0.82[0.78 - 0.86])的表现显著优于出生体重(0.74[0.69 - 0.79])或胎龄(0.71[0.66 - 0.76]),而CRIB-II(0.69[0.64 - 0.74])则明显不如CRIB,且与出生体重或胎龄无显著差异。在计算CRIB-II时,用出生后12小时内最差的BE替代入院时的BE,未发现实质性变化。
与CRIB、出生体重或胎龄相比,CRIB-II并不能更好地评估极低出生体重婴儿的死亡风险。