Department of Pediatrics, The University of Chicago, Chicago, IL.
Division of Pediatric Critical Care, Department of Pediatrics, Advocate Children's Hospital, Oak Lawn, IL.
Pediatr Crit Care Med. 2019 Aug;20(8):722-727. doi: 10.1097/PCC.0000000000001999.
Short-term and long-term morbidity and mortality are common following pediatric critical illness. Severe organ dysfunction is associated with significant in-hospital mortality in critically ill children; however, the performance of pediatric organ dysfunction scores as predictors of functional outcomes after critical illness has not been previously assessed.
Secondary analysis of a prospective observational cohort.
A multidisciplinary, tertiary, academic PICU.
Patients less than or equal to 18 years old admitted between June 2012 and August 2012.
None.
The maximum pediatric Sequential Organ Failure Assessment and Pediatric Logistic Organ Dysfunction-2 scores during admission were calculated. The Functional Status Scale score was obtained at baseline, 6 months and 3 years following discharge. New morbidity was defined as a change in Functional Status Scale greater than or equal to 3 points from baseline. The performance of organ dysfunction scores at discriminating new morbidity or mortality at 6 months and 3 years was measured using the area under the curve. Seventy-three patients met inclusion criteria. Fourteen percent had new morbidity or mortality at 6 months and 23% at 3 years. The performance of the maximum pediatric Sequential Organ Failure Assessment and Pediatric Logistic Organ Dysfunction-2 scores at discriminating new morbidity or mortality was excellent at 6 months (areas under the curves 0.9 and 0.88, respectively) and good at 3 years (0.82 and 0.79, respectively).
Severity of organ dysfunction is associated with longitudinal change in functional status and short-term and long-term development of new morbidity and mortality. Maximum pediatric Sequential Organ Failure Assessment and Pediatric Logistic Organ Dysfunction-2 scores during critical illness have good to excellent performance at predicting new morbidity or mortality up to 3 years after critical illness. Use of these pediatric organ dysfunction scores may be helpful for prognostication of longitudinal functional outcomes in critically ill children.
儿科危重病患者常出现短期和长期的发病率和死亡率。严重的器官功能障碍与危重病儿童的院内死亡率显著相关；然而，儿科器官功能障碍评分作为预测危重病后功能结局的指标尚未得到评估。
前瞻性观察队列的二次分析。
多学科、三级、学术性儿科重症监护病房。
2012 年 6 月至 8 月期间入院的年龄不超过 18 岁的患者。
无。
计算了住院期间最大儿科序贯器官衰竭评估和儿科逻辑器官功能障碍-2 评分。在出院时基线、6 个月和 3 年时获得功能状态量表评分。新发病是指与基线相比功能状态量表评分增加≥3 分。使用曲线下面积来衡量器官功能障碍评分在 6 个月和 3 年时区分新发发病率或死亡率的性能。73 例患者符合纳入标准。14%的患者在 6 个月时出现新发发病率或死亡率，23%的患者在 3 年时出现新发发病率或死亡率。最大儿科序贯器官衰竭评估和儿科逻辑器官功能障碍-2 评分在 6 个月时区分新发发病率或死亡率的性能优异（曲线下面积分别为 0.9 和 0.88），在 3 年时也较好（分别为 0.82 和 0.79）。
器官功能障碍的严重程度与功能状态的纵向变化以及短期和长期新发病发病率和死亡率有关。危重病期间的最大儿科序贯器官衰竭评估和儿科逻辑器官功能障碍-2 评分在预测危重病后 3 年内新发病发病率或死亡率方面具有良好至优秀的性能。使用这些儿科器官功能障碍评分可能有助于预测危重病儿童的纵向功能结局。
