Leclerc Francis, Duhamel Alain, Deken Valérie, Grandbastien Bruno, Leteurtre Stéphane
1CHU Lille, Service de réanimation pédiatrique, Lille, France. 2Univ. Lille, EA 2694 Santé publique, épidémiologie et qualité des soins, Lille, France. 3CHU Lille, Département de biostatistiques, Lille, France. 4CHU Lille, Service de gestion du risque infectieux, des vigilances et d'infectiologie (SGRIVI), Lille, France.
Pediatr Crit Care Med. 2017 Aug;18(8):758-763. doi: 10.1097/PCC.0000000000001182.
A recent task force has proposed the use of Sequential Organ Failure Assessment in clinical criteria for sepsis in adults. We sought to evaluate the predictive validity for PICU mortality of the Pediatric Logistic Organ Dysfunction-2 and of the "quick" Pediatric Logistic Organ Dysfunction-2 scores on day 1 in children with suspected infection.
Secondary analysis of the database used for the development and validation of the Pediatric Logistic Organ Dysfunction-2.
Nine university-affiliated PICUs in Europe.
Only children with hypotension-low systolic blood pressure or low mean blood pressure using age-adapted cutoffs-and lactatemia greater than 2 mmol/L were considered in shock.
We developed the quick Pediatric Logistic Organ Dysfunction-2 score on day 1 including tachycardia, hypotension, and altered mentation (Glasgow < 11): one point for each variable (range, 0-3). Outcome was mortality at PICU discharge. Discrimination (Area under receiver operating characteristic curve-95% CI) and calibration (goodness of fit test) of the scores were studied. This study included 862 children with suspected infection (median age: 12.3 mo; mortality: n = 60 [7.0%]). Area under the curve of the Pediatric Logistic Organ Dysfunction-2 score on day 1 was 0.91 (0.86-0.96) in children with suspected infection, 0.88 (0.79-0.96) in those with low systolic blood pressure and hyperlactatemia, and 0.91 (0.85-0.97) in those with low mean blood pressure and hyperlactatemia; calibration p value was 0.03, 0.36, and 0.49, respectively. A Pediatric Logistic Organ Dysfunction-2 score on day 1 greater than or equal to 8 reflected an overall risk of mortality greater than or equal to 9.3% in children with suspected infection. Area under the curve of the quick Pediatric Logistic Organ Dysfunction-2 score on day 1 was 0.82 (0.76-0.87) with systolic blood pressure or mean blood pressure; calibration p value was 0.89 and 0.72, respectively. A score greater than or equal to 2 reflected a mortality risk greater than or equal to 19.8% with systolic blood pressure and greater than or equal to 15.9% with mean blood pressure.
Among children admitted to PICU with suspected infection, Pediatric Logistic Organ Dysfunction-2 score on day 1 was highly predictive of PICU mortality suggesting its use to standardize definitions and diagnostic criteria of pediatric sepsis. Further studies are needed to determine the usefulness of the quick Pediatric Logistic Organ Dysfunction-2 score on day 1 outside of the PICU.
最近一个特别工作组提议将序贯器官衰竭评估用于成人脓毒症的临床标准。我们试图评估儿童逻辑器官功能障碍评分-2（Pediatric Logistic Organ Dysfunction-2，PELOD-2）及“快速”PELOD-2评分对疑似感染儿童入住儿科重症监护病房（PICU）时死亡率的预测效度。
对用于开发和验证PELOD-2的数据库进行二次分析。
欧洲9家大学附属医院的PICU。
仅将使用适合年龄的临界值判定为低血压（收缩压低或平均血压低）且血乳酸水平大于2 mmol/L的儿童视为处于休克状态。
我们制定了第1天的快速PELOD-2评分，包括心动过速、低血压和精神状态改变（格拉斯哥昏迷评分<11分）：每个变量计1分（范围为0 - 3分）。转归指标为PICU出院时的死亡率。研究了评分的辨别力（受试者工作特征曲线下面积-95%CI）和校准情况（拟合优度检验）。本研究纳入了862例疑似感染儿童（中位年龄：12.3个月；死亡率：n = 60 [7.0%]）。疑似感染儿童第1天的PELOD-2评分曲线下面积为0.91（0.86 - 0.96），收缩压低且血乳酸水平高的儿童为0.88（0.79 - 0.96），平均血压低且血乳酸水平高的儿童为0.91（0.85 - 0.97）；校准p值分别为0.03、0.36和0.49。第1天PELOD-2评分大于或等于8分表明疑似感染儿童的总体死亡风险大于或等于9.3%。第1天快速PELOD-2评分曲线下面积在收缩压或平均血压方面为0.82（0.76 - 0.87）；校准p值分别为0.89和0.
