Néonatologie, Réanimation Néonatale et Pédiatrique, CHU La Réunion-Site Sud, Saint Pierre, France.
PLoS One. 2013 Apr 16;8(4):e62210. doi: 10.1371/journal.pone.0062210. Print 2013.
We aimed to investigate the predictive value for severe adverse outcome of plasma protein measurements on day one of life in very preterm infants and to compare total plasma protein levels with the validated illness severity scores CRIB, CRIB-II, SNAP-II and SNAPPE-II, regarding their predictive ability for severe adverse outcome.
We analyzed a cohort of infants born at 24-31 weeks gestation, admitted to the tertiary intensive care unit of a university hospital over 10.5 years. The outcome measure was "severe adverse outcome" defined as death before discharge or severe neurological injury on cranial ultrasound. The adjusted odd ratio (aOR) and 95% confidence interval (95% CI) of severe adverse outcome for hypoproteinemia (total plasma protein level <40 g/L) was calculated by univariate and multivariate analyses. Calibration (Hosmer-Lemeshow goodness-of-fit) was performed and the predictive ability for severe adverse outcome was assessed for total plasma protein and compared with CRIB, CRIB-II, SNAP-II and SNAPPE-II, by calculating receiver operating characteristic (ROC) curves and their associated area under the curve (AUC).
761 infants were studied: 14.4% died and 4.1% survived with severe cerebral ultrasound findings. The aOR of severe adverse outcome for hypoproteinemia was 6.1 (95% CI 3.8-9.9). The rank order for variables, as assessed by AUCs and 95% CIs, in predicting outcome was: total plasma protein [0.849 (0.821-0.873)], SNAPPE-II [0.822 (0.792-0.848)], CRIB [0.821 (0.792-0.848)], SNAP-II [0.810 (0.780-0.837)] and CRIB-II [0.803 (0.772-0.830)]. Total plasma protein predicted severe adverse outcome significantly better than CRIB-II and SNAP-II (both p<0.05). Calibration for total plasma protein was very good.
Early hypoproteinemia has prognostic value for severe adverse outcome in very preterm, sick infants. Total plasma protein has a predictive performance comparable with CRIB and SNAPPE-II and greater than other validated severity scores.
我们旨在研究极低出生体重儿生后第 1 天的血浆蛋白测量值对严重不良结局的预测价值，并比较总血浆蛋白水平与经过验证的疾病严重程度评分 CRIB、CRIB-II、SNAP-II 和 SNAPPE-II，以评估其对严重不良结局的预测能力。
我们分析了在一所大学医院的三级重症监护病房接受治疗的 24-31 周龄早产儿队列。结局测量为“严重不良结局”，定义为出院前死亡或头颅超声显示严重神经损伤。通过单变量和多变量分析计算低蛋白血症（总血浆蛋白水平<40 g/L）的严重不良结局的调整比值比（aOR）和 95%置信区间（95%CI）。进行校准（Hosmer-Lemeshow 拟合优度），并通过计算受试者工作特征（ROC）曲线及其相关曲线下面积（AUC），评估总血浆蛋白和 CRIB、CRIB-II、SNAP-II 和 SNAPPE-II 对严重不良结局的预测能力。
研究了 761 名婴儿：14.4%死亡，4.1%存活且头颅超声发现严重异常。低蛋白血症的严重不良结局的 aOR 为 6.1（95%CI 3.8-9.9）。根据 AUC 和 95%CI 评估的预测结局的变量等级顺序为：总血浆蛋白[0.849（0.821-0.873）]、SNAPPE-II[0.822（0.792-0.848）]、CRIB[0.821（0.792-0.848）]、SNAP-II[0.810（0.780-0.837）]和 CRIB-II[0.803（0.772-0.830）]。总血浆蛋白预测严重不良结局的能力明显优于 CRIB-II 和 SNAP-II（均 p<0.05）。总血浆蛋白的校准效果非常好。
极低出生体重、患病婴儿的早期低蛋白血症对严重不良结局具有预后价值。总血浆蛋白的预测性能与 CRIB 和 SNAPPE-II 相当，优于其他经过验证的严重程度评分。
