Department of Pediatrics and.
Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland.
Am J Respir Crit Care Med. 2022 Jan 1;205(1):75-87. doi: 10.1164/rccm.202106-1359OC.
Use of severity of illness scores to classify patients for clinical care and research is common outside of the neonatal ICU. Extremely premature (<29 weeks' gestation) infants with extremely low birth weight (<1,000 g) experience significant mortality and develop severe pathology during the protracted birth hospitalization. To measure at high resolution the changes in organ dysfunction that occur from birth to death or discharge home by gestational age and time, and among extremely preterm infants with and without clinically meaningful outcomes using the neonatal sequential organ failure assessment score. A single-center, retrospective, observational cohort study of inborn, extremely preterm infants with extremely low birth weight admitted between January 2012 and January 2020. Neonatal sequential organ failure assessment scores were calculated every hour for every patient from admission until death or discharge. Longitudinal, granular scores from 436 infants demonstrated early and sustained discrimination of those who died versus those who survived to discharge. The discrimination for mortality by the maximum score was excellent (area under curve, 0.91; 95% confidence intervals, 0.88-0.94). Among survivors with and without adverse outcomes, most score variation occurred at the patient level. The weekly average score over the first 28 days was associated with the sum of adverse outcomes at discharge. The neonatal sequential organ failure assessment score discriminates between survival and nonsurvival on the first day of life. The major contributor to score variation occurred at the patient level. There was a direct association between scores and major adverse outcomes, including death.
使用疾病严重程度评分来对患者进行临床护理和研究在新生儿 ICU 之外很常见。极早产（<29 周妊娠）且极低出生体重（<1000 克）的婴儿在延长的分娩住院期间经历着显著的死亡率和严重的病理变化。为了以高分辨率测量从出生到死亡或出院回家的器官功能障碍变化，以及使用新生儿序贯器官衰竭评估评分来衡量具有和不具有临床意义结局的极早产儿之间的变化。这是一项单中心、回顾性、观察性队列研究，纳入了 2012 年 1 月至 2020 年 1 月期间入院的极早产、极低出生体重的新生儿。从入院开始，每小时为每位患者计算一次新生儿序贯器官衰竭评估评分，直到死亡或出院。来自 436 名婴儿的纵向、粒度评分显示，早期和持续区分了死亡和存活至出院的患者。死亡率的最高评分具有极好的区分能力（曲线下面积为 0.91；95%置信区间为 0.88-0.94）。在有和没有不良结局的幸存者中，大多数评分变化发生在患者水平。前 28 天的每周平均评分与出院时的不良结局总和相关。新生儿序贯器官衰竭评估评分在生命的第一天即可区分存活和非存活患者。评分变化的主要贡献来自患者水平。评分与主要不良结局（包括死亡）之间存在直接关联。
