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中国一家儿科重症监护病房中儿童死亡风险、儿童死亡率指数及儿童死亡率指数2模型的比较:一项验证研究。

Comparison of the pediatric risk of mortality, pediatric index of mortality, and pediatric index of mortality 2 models in a pediatric intensive care unit in China: A validation study.

作者信息

Qiu Jun, Lu Xiulan, Wang Kewei, Zhu Yimin, Zuo Chao, Xiao Zhenghui

机构信息

Department of Children's Intensive Research Center, Hunan Children's Hospital, Changsha, China.

出版信息

Medicine (Baltimore). 2017 Apr;96(14):e6431. doi: 10.1097/MD.0000000000006431.

Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d13/5411191/da46ee872b45/medi-96-e6431-g004.jpg

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