Zhang Zhengzheng, Huang Xiangyuan, Wang Ying, Li Ying, Miao Hongjun, Zhang Chenmei, Pan Guoquan, Zhang Yucai, Zhu Xiaodong, Chen Weiming, Li Juanzhen, Su Dongni, Bi Yanlong, Chen Zhenjie, Jin Bingxin, Miao Huijie, Kong Xiangmei, Cheng Ye, Chen Yang, Yan Gangfeng, Yan Weili, Lu Guoping
Pediatric Emergency and Critical Care Center, Children's Hospital of Fudan University, Shanghai, China.
Department of Clinical Epidemiology, Children's Hospital of Fudan University, Shanghai, China.
Front Pediatr. 2020 Sep 8;8:522. doi: 10.3389/fped.2020.00522. eCollection 2020.
The mortality prediction scores were widely used in pediatric intensive care units. However, their performances were unclear in Chinese patients and there were also no reports based on large sample sizes in China. This study aims to evaluate the performances of three existing severity assessment scores in predicting PICU mortality and to identify important determinants. This prospective observational cohort study was carried out in eight multidisciplinary, tertiary-care PICUs of teaching hospitals in China. All eligible patients admitted to the PICUs between Aug 1, 2016, and Jul 31, 2017, were consecutively enrolled, among whom 3,957 were included for analysis. We calculated PCIS, PRISM IV, and PELOD-2 scores based on patient data collected in the first 24 h after PICU admission. The in-hospital mortality was defined as all-cause death within 3 months after admission. The discrimination of mortality was assessed using the area under the receiver-operating characteristics curve (AUC) and calibrated using the Hosmer-Lemeshow goodness-of-fit test. A total of 4,770 eligible patients were recruited (median age 18.2 months, overall mortality rate 4.7%, median length of PICU stay 6 days), and 3,957 participants were included in the analysis. The AUC (95% confidence intervals, CI) were 0.74 (0.71-0.78), 0.76 (0.73-0.80), and 0.80 (0.77-0.83) for PCIS, PRISM IV, and PELOD-2, respectively. The Hosmer-Lemeshow test gave a chi-square of 3.16 for PCIS, 2.16 for PRISM IV and 4.81 for PELOD-2 ( ≥ 0.19). Cox regression identified five predictors from the items of scores better associated with higher death risk, with a C-index of 0.83 (95%CI 0.79-0.86), including higher platelet (HR = 1.85, 95% CI 1.59-2.16), invasive ventilation (HR = 1.40, 1.26-1.55), pupillary light reflex (HR = 1.31, 95% CI 1.22-1.42) scores, lower pH (HR 0.89, 0.84-0.94), and extreme PaO (HR 2.60, 95% CI 1.61-4.19 for the 1st quantile vs. 4th quantile) scores. Performances of the three scores in predicting PICU mortality are comparable, and five predictors were identified with better prediction to PICU mortality in Chinese patients.
死亡率预测评分在儿科重症监护病房中被广泛应用。然而，其在中国患者中的表现尚不清楚，且国内也没有基于大样本量的报告。本研究旨在评估三种现有的严重程度评估评分在预测儿科重症监护病房死亡率方面的表现，并确定重要的决定因素。这项前瞻性观察性队列研究在中国教学医院的8个多学科三级护理儿科重症监护病房中进行。2016年8月1日至2017年7月31日期间入住儿科重症监护病房的所有符合条件的患者均被连续纳入，其中3957例被纳入分析。我们根据儿科重症监护病房入院后前24小时收集的患者数据计算了儿科综合病情评分（PCIS）、小儿死亡风险评估系统第四版（PRISM IV）和小儿死亡概率模型第二版（PELOD-2）评分。住院死亡率定义为入院后3个月内的全因死亡。使用受试者工作特征曲线下面积（AUC）评估死亡率的辨别能力，并使用Hosmer-Lemeshow拟合优度检验进行校准。共招募了4770例符合条件的患者（中位年龄18.2个月，总死亡率4.7%，儿科重症监护病房中位住院时间6天），3957名参与者被纳入分析。PCIS、PRISM IV和PELOD-2的AUC（95%置信区间，CI）分别为0.74（0.71-0.78）、0.76（0.73-0.80）和0.80（0.77-0.83）。Hosmer-Lemeshow检验得出PCIS的卡方值为3.16，PRISM IV为2.16，PELOD-2为4.81（≥0.19）。Cox回归从与较高死亡风险相关性更强的评分项目中确定了5个预测因素，C指数为0.83（95%CI 0.79-0.86），包括较高的血小板计数（HR = 1.85，95%CI 1.59-2.16）、有创通气（HR = 1.40，1.26-1.55）、瞳孔对光反射（HR = 1.31，95%CI 1.22-1.42）评分、较低的pH值（HR 0.89，0.84-0.94）以及极低的动脉血氧分压（第1四分位数与第4四分位数相比，HR 2.60，95%CI 1.61-4.19）评分。这三种评分在预测儿科重症监护病房死亡率方面的表现相当，并且确定了5个预测因素，对中国患者的儿科重症监护病房死亡率有更好的预测作用。
