儿科脓毒症诱导性凝血功能障碍评分在诊断脓毒症诱导性凝血功能障碍及预测儿童预后中的临床价值。
Clinical value of pediatric sepsis-induced coagulopathy score in diagnosis of sepsis-induced coagulopathy and prognosis in children.
机构信息
Department of Critical Care Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
出版信息
J Thromb Haemost. 2021 Dec;19(12):2930-2937. doi: 10.1111/jth.15500. Epub 2021 Sep 22.
BACKGROUND
In adults, sepsis-induced coagulopathy (SIC) is diagnosed by the SIC score, known as sepsis-3. There is no pediatric SIC (pSIC) score at present.
OBJECTIVES
We proposed a pSIC scoring method and evaluated the diagnostic efficacy of the score in the diagnosis of SIC in children.
PATIENTS/METHODS: Patient data were retrospectively analyzed from Shanghai Children's Medical Center between February 2014 and January 2015. The pSIC score was modified from the SIC score. The area under ROC curve (AU-ROC) was used to compare the prognostic values of pSIC with other scores for pediatric sepsis-induced disseminated intravascular coagulation (DIC) to arrive at a 28-day outcome.
RESULTS AND CONCLUSIONS
There were 54 patients in the pSIC group and 37 in the non-pSIC group. The Kaplan-Meier survival curve analysis showed that the 28-day prognosis was better in the non-pSIC than in the pSIC group (p < .001). The AU-ROC of the pSIC score in predicting 28-day mortality in sepsis was 0.716, with the optimal cutoff value of >3 inferior to that of pediatric sequential organ failure (0.716 vs. 0.921, p < .001). The AU-ROC of pSIC in predicting nonovert DIC was 0.845 and the optimal cutoff value was >3. The AU-ROC of pSIC in predicting overt DIC was 0.901, with the best optimal cutoff value of >4. The pSIC score can be used to diagnose SIC in children, screen potential nonovert DIC, and assess the severity of sepsis, organ dysfunction, and 28-day outcome in children.
背景
在成年人中，脓毒症诱导的凝血障碍（SIC）通过 SIC 评分（即脓毒症-3）进行诊断。目前尚无儿科 SIC（pSIC）评分。
目的
我们提出了一种 pSIC 评分方法，并评估了该评分在儿童 SIC 诊断中的诊断效能。
患者/方法：回顾性分析了 2014 年 2 月至 2015 年 1 月上海儿童医学中心收治的患者。pSIC 评分是从 SIC 评分修改而来的。采用 ROC 曲线下面积（AU-ROC）比较 pSIC 与其他评分对儿童脓毒症诱导的弥散性血管内凝血（DIC）的预后价值，以预测 28 天结局。
结果与结论
pSIC 组 54 例，非 pSIC 组 37 例。Kaplan-Meier 生存曲线分析显示，非 pSIC 组 28 天预后优于 pSIC 组（p < 0.001）。pSIC 评分预测脓毒症 28 天死亡率的 AU-ROC 为 0.716，最佳截断值>3 优于儿科序贯器官衰竭评分（0.716 比 0.921，p < 0.001）。pSIC 预测非显性 DIC 的 AU-ROC 为 0.845，最佳截断值>3。pSIC 预测显性 DIC 的 AU-ROC 为 0.901，最佳截断值>4。pSIC 评分可用于诊断儿童 SIC，筛查潜在的非显性 DIC，并评估儿童脓毒症的严重程度、器官功能障碍和 28 天结局。
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