预测因世界卫生组织定义的严重社区获得性肺炎而住院的五岁以下儿童的死亡率和使用 RISC 评分系统。
Predicting Mortality and Use of RISC Scoring System in Hospitalized Under-Five Children Due to WHO Defined Severe Community Acquired Pneumonia.
机构信息
Division of Neonatology, All India Institute of Medical Sciences, New Delhi, India.
Department of Pediatrics, King George's Medical University, Lucknow, India.
出版信息
J Trop Pediatr. 2022 Jun 6;68(4). doi: 10.1093/tropej/fmac050.
BACKGROUND
Pneumonia acquired in the community is a leading cause of hospitalization and death in under-five children. Predicting mortality in children remains a challenge. There is a need of consolidated scoring system to predict mortality in under-five children in developing nations.
METHODS
This is a hospital-based prospective nested case-control study, conducted in a tertiary care teaching hospital of north India. Included were under-five hospitalized children due to WHO defined severe community acquired pneumonia (CAP). Those who did not survive were categorized as cases, while those who were discharged were categorized as controls.
RESULTS
The mortality rate among the recruited 180 hospitalized children with severe CAP was 9.4%. The mortality in under-five children was higher among infants, children who resided in rural areas and were unimmunized or partially immunized for the present age. Mortality was also statistically significantly higher among under-five children with weight for age and weight for length/height below -2Z score; SpO2 < 90% at room air at admission, cyanosis, convulsion, high C-reactive protein (CRP), blood culture positive sepsis and end point consolidation. These predictors were found to be independent risk factors for the mortality after analyzing in multivariate model while presence of wheeze and exclusive breast feeding for first six months of life were found to be protective. The receiver operating characteristic (ROC) curve for respiratory index of severity in children (RISC) score has area under curve (AUC) 0.91 while AUC of RISC score with King George's Medical University (KGMU) modification has 0.88 for prediction of mortality. At the cut-off level of 3, the sensitivity of the RISC score in predicting mortality was 94.1% while the specificity was 73.6%. However, the sensitivity of the RISC score with KGMU modification in predicting mortality at cut-off level of 3 was 88.4% with a specificity of 74.8%.
CONCLUSION
Various predictors for mortality under-five children are young age, malnutrition, cyanosis, high CRP, blood culture positive sepsis and end point consolidation. It is also possible to predict mortality using RISC score which comprises simple variables and can be easily used at centers of periphery. Similar accuracy had been also found through the use of an age independent modified score (RISC score with KGMU modification).Lay summaryPneumonia is a primary cause of hospitalization as well as death among the children under the age of five. A variety of severity or mortality predicting scores have been produced for adults, but such scores for children are scarce. Furthermore, their utility in developing nations has not been proven. This is a hospital-based prospective study. Included were children under five (2 to 59 months) hospitalized due to severe community acquired pneumonia (CAP) defined as per World Health Organization (WHO) and were not hospitalized in last 14 days elsewhere. Those who did not survive were classified as cases while those who were discharged were classified as controls. A total of 200 consecutively hospitalized children with severe CAP based on WHO were screened and 180 children were recruited. Among recruited children, the percentage of mortality was 9.4% while 90.6% were discharged. The mortality was higher among children younger than 12 months, those belonged to rural area and were unimmunized or partially immunized for the present age. Mortality was also higher among under-five children with severe malnutrition, anemia, SpO2 < 90% at room air at admission, cyanosis, convulsion, thrombocytopenia, high CRP, blood culture positive sepsis and end point consolidation. After assessing in a multivariate model, these predictors were determined to be independent risk factor for death, while wheezing and exclusive breast feeding throughout the first six months of life were found to be protective. The receiver operating characteristic (ROC) curve for respiratory index of severity in children (RISC) score has an area under curve (AUC) of 0.91 while AUC of RISC score with King George's Medical University (KGMU) modification was 0.88 for the prediction of death in under-five children hospitalized due to severe CAP.
背景
社区获得性肺炎是导致五岁以下儿童住院和死亡的主要原因。预测儿童死亡率仍然是一个挑战。发展中国家需要一个综合的评分系统来预测五岁以下儿童的死亡率。
方法
这是一项在印度北部一家三级教学医院进行的基于医院的前瞻性嵌套病例对照研究。纳入的是因世界卫生组织（WHO）定义的严重社区获得性肺炎（CAP）而住院的五岁以下儿童。那些未存活的患儿被归类为病例，而那些出院的患儿被归类为对照。
结果
在招募的 180 名患有严重 CAP 的住院儿童中，死亡率为 9.4%。婴儿、居住在农村地区、未按当前年龄进行免疫或部分免疫的儿童以及体重和身长/身高低于-2Z 评分的儿童死亡率较高；入院时血氧饱和度（SpO2）在室温空气下<90%、发绀、抽搐、高 C 反应蛋白（CRP）、血培养阳性败血症和终点实变的儿童死亡率也有统计学显著升高。在多变量模型中分析后，这些预测因素被发现是死亡率的独立危险因素，而喘息和前六个月纯母乳喂养被发现是保护性因素。儿童严重度呼吸指数（RISC）评分的受试者工作特征（ROC）曲线的曲线下面积（AUC）为 0.91，而经 King George's Medical University（KGMU）修正的 RISC 评分的 AUC 为 0.88，用于预测死亡率。在 3 的截断水平下，RISC 评分预测死亡率的灵敏度为 94.1%，特异性为 73.6%。然而，在截断水平为 3 时，经 KGMU 修正的 RISC 评分预测死亡率的灵敏度为 88.4%，特异性为 74.8%。
结论
五岁以下儿童死亡的预测指标有年龄较小、营养不良、发绀、高 CRP、血培养阳性败血症和终点实变。使用 RISC 评分也可以预测死亡率，该评分包括简单的变量，并且可以在中心或周边地区方便地使用。通过使用年龄独立的改良评分（带有 KGMU 修正的 RISC 评分）也可以获得类似的准确性。
概述
肺炎是五岁以下儿童住院和死亡的主要原因。已经为成年人产生了各种严重程度或死亡率预测评分，但儿童的此类评分却很少。此外，它们在发展中国家的实用性尚未得到证明。这是一项基于医院的前瞻性研究。纳入的是因世界卫生组织（WHO）定义的严重社区获得性肺炎（CAP）而住院的五岁以下（2 至 59 个月）儿童，且他们在过去 14 天内没有在其他地方住院。那些未存活的患儿被归类为病例，而那些出院的患儿被归类为对照。根据 WHO 的标准，对 200 名连续住院的严重 CAP 患儿进行了筛查，其中 180 名患儿被招募。在招募的患儿中，死亡率为 9.4%，90.6%的患儿出院。年龄较小的儿童、来自农村地区且未按当前年龄进行免疫或部分免疫的儿童以及严重营养不良、贫血、入院时 SpO2 在室温空气下<90%、发绀、抽搐、血小板减少、高 CRP、血培养阳性败血症和终点实变的儿童死亡率较高。在多变量模型中评估后，这些预测因素被确定为死亡的独立危险因素，而喘息和前六个月纯母乳喂养被发现是保护性因素。儿童严重度呼吸指数（RISC）评分的受试者工作特征（ROC）曲线的曲线下面积（AUC）为 0.91，而经 King George's Medical University（KGMU）修正的 RISC 评分的 AUC 为 0.88，用于预测因严重 CAP 住院的五岁以下儿童的死亡。
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