Qiu Jun, Lu Xiulan, Wang Kewei, Zhu Yimin, Zuo Chao, Xiao Zhenghui
Department of Children's Intensive Research Center, Hunan Children's Hospital, Changsha, China.
Medicine (Baltimore). 2017 Apr;96(14):e6431. doi: 10.1097/MD.0000000000006431.
This study was designed with the aim of comparing the performances of the pediatric risk of mortality (PRISM), pediatric index of mortality (PIM), and revised version pediatric index of mortality 2 (PIM2) models in a pediatric intensive care unit (PICU) in China.A total of 852 critically ill pediatric patients were recruited in the study between January 1 and December 31, 2014. The variables required to calculate PRISM, PIM, and PIM2 were collected. Mode l performance was evaluated by assessing the calibration and discrimination. Discrimination between death and survival was assessed by calculating the area under the receiver-operating characteristic curve (AUC). Calibration across deciles of risk was evaluated using the Hosmer-Lemeshow goodness-of-fit χ test.Of the 852 patients enrolled in this study, 745 patients survived until the end of the PICU stay (107 patients died, 12.56%). The AUCs (95% confidence intervals, CI) were 0.729 (0.670-0.788) for PRISM, 0.721 (0.667-0.776) for PIM, and 0.726 (0.671-0.781) for PIM2. The Hosmer-Lemeshow test revealed a chi-square of 7.26 (P = 0.51, v = 10) for PRISM, 26.28 (P = 0.0009, v = 10) for PIM, and 10.28 (P = 0.21, v = 10) for PIM2. The standardized mortality rate was 1.14 (95%CI: 0.93-1.36) for PRISM, 1.89 (95%CI: 1.55-2.27) for PIM, and 2.13 (95%CI: 1.75-2.55) for PIM2.The PRISM, PIM, and PIM2 scores demonstrated an acceptable discriminatory performance. With the exception of PIM, the PRISM and PIM2 models had good calibrations.
本研究旨在比较儿童死亡风险(PRISM)、儿童死亡率指数(PIM)和修订版儿童死亡率指数2(PIM2)模型在中国一家儿科重症监护病房(PICU)中的表现。2014年1月1日至12月31日期间,共有852名危重症儿童患者被纳入本研究。收集了计算PRISM、PIM和PIM2所需的变量。通过评估校准和区分度来评价模型性能。通过计算受试者工作特征曲线(AUC)下的面积来评估死亡与存活之间的区分度。使用Hosmer-Lemeshow拟合优度χ检验评估风险十分位数的校准情况。在本研究纳入的852例患者中,745例患者存活至PICU住院结束(107例患者死亡,12.56%)。PRISM的AUC(95%置信区间,CI)为0.729(0.670 - 0.788),PIM为0.721(0.667 - 0.776),PIM2为0.726(0.671 - 0.781)。Hosmer-Lemeshow检验显示,PRISM的卡方值为7.26(P = 0.51,v = 10),PIM为26.28(P = 0.0009,v = 10),PIM2为10.28(P = 0.21,v = 1)。PRISM的标准化死亡率为1.14(95%CI:0.93 - 1.36),PIM为1.89(95%CI:1.55 - 2.27),PIM2为2.13(9%CI:1.75 - 2.55)。PRISM、PIM和PIM2评分显示出可接受的区分性能。除PIM外,PRISM和PIM2模型具有良好的校准。