Pediatric Intensive Care Unit, the Department of Biostatistics, Université Lille Nord de France, UDSL, EA 2694, Centre hospitalier universitaire Lille, Lille, France.
CMAJ. 2010 Aug 10;182(11):1181-7. doi: 10.1503/cmaj.081715. Epub 2010 Jun 14.
Daily evaluation of multiple organ dysfunction syndrome has been performed in critically ill adults. We evaluated the clinical course of multiple organ dysfunction over time in critically ill children using the Pediatric Logistic Organ Dysfunction (PELOD) score and determined the optimal days for measuring scores.
We prospectively measured daily PELOD scores and calculated the change in scores over time for 1806 consecutive patients admitted to seven pediatric intensive care units (PICUs) between September 1998 and February 2000. To study the relationship between daily scores and mortality in the PICU, we evaluated changes in daily scores during the first four days; the mean rate of change in scores during the entire PICU stay between survivors and nonsurvivors; and Cox survival analyses using a change in PELOD score as a time-dependent covariate to determine the optimal days for measuring daily scores.
The overall mortality among the 1806 patients was 6.4%. A high PELOD score (>or=20 points) on day 1 was associated with an odds ratio (OR) for death of 40.7 (95% confidence interval [CI] 20.3-81.4); a medium score (10-19 points) on day 1 was associated with an OR for death of 4.2 (95% CI 2.0-8.7). Mortality was 50% when a high score on day 1 increased on day 2. The course of daily PELOD scores differed between survivors and nonsurvivors. A set of seven days (days 1, 2, 5, 8, 12, 16 and 18) was identified as the optimal period for measurement of daily PELOD scores.
PELOD scores indicating a worsening condition or no improvement over time were indicators of a poor prognosis in the PICU. A set of seven days for measurement of the PELOD score during the PICU stay provided optimal information on the progression of multiple-organ dysfunction syndrome in critically ill children.
已对重症成人进行了每日多器官功能障碍综合征的评估。我们使用儿科逻辑器官功能障碍评分（PELOD）评估了 1806 例连续入住 7 个儿科重症监护病房（PICU）的危重病儿在一段时间内多器官功能障碍的临床病程，并确定了测量评分的最佳天数。
我们前瞻性地测量了每日 PELOD 评分，并计算了 1998 年 9 月至 2000 年 2 月间连续入住 7 个儿科重症监护病房的 1806 例患儿的评分随时间的变化。为了研究 PICU 内每日评分与死亡率之间的关系，我们评估了前 4 天内每日评分的变化；计算存活者和非存活者整个 PICU 住院期间评分变化的平均速率；并使用 PELOD 评分的变化作为时间依赖性协变量进行 Cox 生存分析，以确定测量每日评分的最佳天数。
1806 例患儿的总体死亡率为 6.4%。第 1 天高（>或=20 分）PELOD 评分与死亡的比值比（OR）为 40.7（95%置信区间[CI] 20.3-81.4）；第 1 天中（10-19 分）评分与死亡的 OR 为 4.2（95%CI 2.0-8.7）。当第 1 天的高评分在第 2 天增加时，死亡率为 50%。存活者和非存活者的每日 PELOD 评分变化不同。确定了 7 天（第 1、2、5、8、12、16 和 18 天）作为每日 PELOD 评分测量的最佳时期。
PELOD 评分提示病情恶化或无改善提示 PICU 预后不良。在 PICU 住院期间进行 7 天的 PELOD 评分测量可提供有关危重病儿多器官功能障碍综合征进展的最佳信息。
