Jhang Won Kyoung, Kim Young A, Ha Eun Ju, Lee Yoon Jung, Lee Ju Hoon, Park Young Seo, Park Seong Jong
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro-43-gil, Songpa-gu, Seoul, 138-736, Korea.
Pediatr Nephrol. 2014 Jun;29(6):1089-95. doi: 10.1007/s00467-013-2741-z. Epub 2014 Jan 29.
The sequential organ failure assessment (SOFA) score is easy to calculate and has been well validated as an outcome predictor in critically ill adult patients. However, its use in children has been limited, mainly because of differences in basal reference levels of serum creatinine.
Data include 87 patients requiring continuous renal replacement therapy (CRRT) between January 2005 and July 2011. We modified the SOFA score by excluding the renal component to an extrarenal SOFA score, based on the assumption that CRRT may mitigate the renal effect on outcome and investigated the utility in predicting outcome with comparison with pediatric risk of mortality (PRISM) III, pediatric logistic organ dysfunction (PELOD), and SOFA scores.
Results showed that 95.4 % (n = 83) had multiple organ dysfunction syndrome with an overall mortality of 50.6 %. The extrarenal SOFA score at CRRT initiation and ≥20 % fluid overload were significantly associated with mortality. In comparison with the predictive power of various scoring systems, the extrarenal SOFA score showed the largest area under the receiver operating characteristic curve (extrarenal SOFA 0.774, SOFA 0.770, PRISM III 0.660, and PELOD 0.650).
The extrarenal SOFA score may be a useful prognostic marker in critically ill children treated with CRRT.
序贯器官衰竭评估（SOFA）评分易于计算，并且在危重症成年患者中作为预后预测指标已得到充分验证。然而，其在儿童中的应用有限，主要是因为血清肌酐的基础参考水平存在差异。
数据包括2005年1月至2011年7月期间87例需要持续肾脏替代治疗（CRRT）的患者。基于CRRT可能减轻肾脏对预后的影响这一假设，我们通过排除肾脏部分将SOFA评分修改为肾外SOFA评分，并与儿科死亡风险（PRISM）III、儿科逻辑器官功能障碍（PELOD）和SOFA评分相比较，研究其在预测预后方面的效用。
结果显示，95.4%（n = 83）的患者患有多器官功能障碍综合征，总体死亡率为50.6%。开始CRRT时的肾外SOFA评分和≥20%的液体超负荷与死亡率显著相关。与各种评分系统的预测能力相比，肾外SOFA评分在受试者工作特征曲线下的面积最大（肾外SOFA为0.774，SOFA为0.770，PRISM III为0.660，PELOD为0.650）。
肾外SOFA评分可能是接受CRRT治疗的危重症儿童有用的预后标志物。
