测试更新后的儿童脓毒症生物标志物风险模型的预后准确性。
Testing the prognostic accuracy of the updated pediatric sepsis biomarker risk model.
作者信息
Wong Hector R, Weiss Scott L, Giuliano John S, Wainwright Mark S, Cvijanovich Natalie Z, Thomas Neal J, Allen Geoffrey L, Anas Nick, Bigham Michael T, Hall Mark, Freishtat Robert J, Sen Anita, Meyer Keith, Checchia Paul A, Shanley Thomas P, Nowak Jeffrey, Quasney Michael, Chopra Arun, Fitzgerald Julie C, Gedeit Rainer, Banschbach Sharon, Beckman Eileen, Lahni Patrick, Hart Kimberly, Lindsell Christopher J
机构信息
Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, Ohio, United States of America ; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America.
The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America.
出版信息
PLoS One. 2014 Jan 29;9(1):e86242. doi: 10.1371/journal.pone.0086242. eCollection 2014.
BACKGROUND
We previously derived and validated a risk model to estimate mortality probability in children with septic shock (PERSEVERE; PEdiatRic SEpsis biomarkEr Risk modEl). PERSEVERE uses five biomarkers and age to estimate mortality probability. After the initial derivation and validation of PERSEVERE, we combined the derivation and validation cohorts (n = 355) and updated PERSEVERE. An important step in the development of updated risk models is to test their accuracy using an independent test cohort.
OBJECTIVE
To test the prognostic accuracy of the updated version PERSEVERE in an independent test cohort.
METHODS
Study subjects were recruited from multiple pediatric intensive care units in the United States. Biomarkers were measured in 182 pediatric subjects with septic shock using serum samples obtained during the first 24 hours of presentation. The accuracy of PERSEVERE 28-day mortality risk estimate was tested using diagnostic test statistics, and the net reclassification improvement (NRI) was used to test whether PERSEVERE adds information to a physiology-based scoring system.
RESULTS
Mortality in the test cohort was 13.2%. Using a risk cut-off of 2.5%, the sensitivity of PERSEVERE for mortality was 83% (95% CI 62-95), specificity was 75% (68-82), positive predictive value was 34% (22-47), and negative predictive value was 97% (91-99). The area under the receiver operating characteristic curve was 0.81 (0.70-0.92). The false positive subjects had a greater degree of organ failure burden and longer intensive care unit length of stay, compared to the true negative subjects. When adding PERSEVERE to a physiology-based scoring system, the net reclassification improvement was 0.91 (0.47-1.35; p<0.001).
CONCLUSIONS
The updated version of PERSEVERE estimates mortality probability reliably in a heterogeneous test cohort of children with septic shock and provides information over and above a physiology-based scoring system.
背景
我们之前推导并验证了一个用于估计感染性休克患儿死亡概率的风险模型（PERSEVERE；儿科脓毒症生物标志物风险模型）。PERSEVERE使用五种生物标志物和年龄来估计死亡概率。在对PERSEVERE进行初步推导和验证后，我们将推导队列和验证队列合并（n = 355）并对PERSEVERE进行了更新。更新风险模型开发中的一个重要步骤是使用独立测试队列来检验其准确性。
目的
在独立测试队列中检验更新版PERSEVERE的预后准确性。
方法
研究对象来自美国多个儿科重症监护病房。使用在就诊后头24小时内采集的血清样本，对182例感染性休克儿科患者的生物标志物进行了检测。使用诊断测试统计数据检验PERSEVERE对28天死亡风险估计的准确性，并使用净重新分类改善（NRI）来检验PERSEVERE是否能为基于生理学的评分系统增加信息。
结果
测试队列中的死亡率为13.2%。使用2.5%的风险临界值，PERSEVERE对死亡的敏感性为83%（95%CI 62 - 95），特异性为75%（68 - 82），阳性预测值为34%（22 - 47），阴性预测值为97%（91 - 99）。受试者工作特征曲线下面积为0.81（0.70 - 0.92）。与真阴性受试者相比，假阳性受试者的器官衰竭负担更重，重症监护病房住院时间更长。当将PERSEVERE添加到基于生理学的评分系统中时，净重新分类改善为0.91（0.47 - 1.35；p<0.001）。
结论
更新版PERSEVERE在一个异质性的感染性休克患儿测试队列中能够可靠地估计死亡概率，并能提供超出基于生理学评分系统的信息。
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