Leclerc Francis, Duhamel Alain, Deken Valérie, Le Reun Claire, Lacroix Jacques, Leteurtre Stéphane
1Pediatric Intensive Care Unit, Jeanne de Flandre University Hospital, Lille, France. 2Equipe d'accueil n°2694, Université Lille Nord de France, Lille, France. 3Department of Biostatistics, CHU Lille, Lille, France. 4Pediatric Intensive Care Unit, Sainte-Justine Hospital, Université de Montréal, Montréal, QC, Canada.
Pediatr Crit Care Med. 2014 Sep;15(7):590-3. doi: 10.1097/PCC.0000000000000184.
Multiple organ dysfunction, not respiratory failure, is the major cause of death in children with acute lung injury or acute respiratory distress syndrome. This study was undertaken to estimate the predictive value of death of the nonrespiratory Pediatric Logistic Organ Dysfunction-2 in children with acute respiratory failure.
Analysis of the database of the recently published Pediatric Logistic Organ Dysfunction-2.
Nine multidisciplinary, tertiary-care PICU of university-affiliated hospitals in France and Belgium.
All consecutive children (excluding neonates) admitted to these PICUs (June 2006 to October 2007) and having acute respiratory failure.
None.
We prospectively collected data on variables considered for the Pediatric Logistic Organ Dysfunction-2 score during PICU stay up to eight time points: days 1, 2, 5, 8, 12, 16, and 18, plus PICU discharge. For each variable considered in the Pediatric Logistic Organ Dysfunction-2 score, the most abnormal value observed during time points was collected. Outcome was vital status at PICU discharge. We used areas under receiver operating characteristic curve to estimate the discrimination and Hosmer-Lemeshow goodness-of-fit tests to estimate calibration of the Pediatric Logistic Organ Dysfunction-2 and the nonrespiratory Pediatric Logistic Organ Dysfunction-2 scores, with correction for the optimism bias using a bootstrap resampling method. We included 1,572 consecutive patients (median age, 20.6 months; interquartile range, 5.5-80.2; mortality rate, 9.5%). Discrimination of the Pediatric Logistic Organ Dysfunction-2 and the nonrespiratory Pediatric Logistic Organ Dysfunction-2 were excellent (areas under receiver operating characteristic curve = 0.93 and 0.92, respectively) and calibration (chi-square test for goodness-of-fit = 5.8, p = 0.45 and 7.6, p = 0.27, respectively) was good. The four nonrespiratory organ dysfunctions were closely related to the risk of mortality (p< 0.001).
Our study demonstrates that the nonrespiratory Pediatric Logistic Organ Dysfunction-2 score of the entire PICU stay is highly predictive of death in children with acute respiratory failure of whom 94.3% were invasively ventilated. The nonrespiratory Pediatric Logistic Organ Dysfunction-2 score could represent the nonrespiratory organ failure definition tool whose development was recommended in the international expert recommendations on pediatric acute respiratory distress syndrome.
多器官功能障碍而非呼吸衰竭是急性肺损伤或急性呼吸窘迫综合征患儿的主要死亡原因。本研究旨在评估非呼吸性小儿逻辑器官功能障碍评分-2（Pediatric Logistic Organ Dysfunction-2，PELOD-2）对急性呼吸衰竭患儿死亡的预测价值。
对最近发表的小儿逻辑器官功能障碍评分-2数据库进行分析。
法国和比利时9家大学附属医院的多学科三级重症监护病房（PICU）。
所有连续入住这些PICU（2006年6月至2007年10月）且患有急性呼吸衰竭的儿童（不包括新生儿）。
无。
我们前瞻性收集了PICU住院期间长达8个时间点（第1、2、5、8、12、16和18天，外加PICU出院时）用于小儿逻辑器官功能障碍评分-2的变量数据。对于小儿逻辑器官功能障碍评分-2中考虑的每个变量，收集在各时间点观察到的最异常值。结局为PICU出院时的生命状态。我们使用受试者工作特征曲线下面积来评估辨别力，并使用Hosmer-Lemeshow拟合优度检验来评估小儿逻辑器官功能障碍评分-2和非呼吸性小儿逻辑器官功能障碍评分-2的校准情况，采用自助重采样方法校正乐观偏差。我们纳入了1572例连续患者（中位年龄20.6个月；四分位间距5.5 - 80.2；死亡率9.5%）。小儿逻辑器官功能障碍评分-2和非呼吸性小儿逻辑器官功能障碍评分-2的辨别力极佳（受试者工作特征曲线下面积分别为0.93和0.92），校准情况良好（拟合优度的卡方检验分别为5.8，p = 0.45和7.6，p = 0.27）。四种非呼吸器官功能障碍与死亡风险密切相关（p < 0.001）。
我们的研究表明，整个PICU住院期间的非呼吸性小儿逻辑器官功能障碍评分-2对急性呼吸衰竭患儿的死亡具有高度预测性，其中94.3%的患儿接受了有创通气。非呼吸性小儿逻辑器官功能障碍评分-2可代表非呼吸器官衰竭定义工具，国际小儿急性呼吸窘迫综合征专家建议中推荐开发此类工具。
