Song Yue, Wang Hua, Tao Yu-Hong
Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Clin Cases. 2022 May 26;10(15):4799-4809. doi: 10.12998/wjcc.v10.i15.4799.
There is no suitable scoring system that can be used to predict mortality in children with acute paraquat intoxication (APP).
To optimize a predictive scoring system for mortality in children with APP.
A total of 113 children with APP from January 1, 2010 to January 1, 2020 were enrolled in this study. These patients were divided into survivors and non-survivors. We compared the clinical characteristics between the two groups and analyzed the independent prognostic risk factors. The survival rates of patients with different values of the pediatric critical illness score (PCIS) were assessed using kaplan-meier survival analysis. The best scoring system was established by using the area under the receiver operating characteristic curve analysis.
The overall mortality rate was 23.4%. All non-survivors died within 20 days; 48.1% (13/27) died within 3 days, and 70.3% (19/27) died within 7 days. Compared to survivors, the non-survivors were older, had higher white blood cell count, alanine aminotransferase (ALT), aspartate aminotransferase, serum creatinine, blood urea nitrogen, glucose, and pediatric early warning score, and had lower platelet count, albumin, Serum sodium (Na) and PCIS. ALT and PCIS were the independent prognostic risk factors for children with APP. The survival rate of children classified as extremely critical patients (100%) was lower than that of children classified as critical (60%) or noncritical (6.7%) patients. The specificity of ALT was high (96.51%), but the sensitivity was low (59.26%). The sensitivity and specificity of ALT combined with PCIS were high, 92.59% and 87.21%, respectively. The difference in mortality was significantly higher for ALT combined with PCIS (area under the receiver operating characteristic: 0.937; 95%CI: 0.875-0.974; < 0.05).
In our study, ALT and PCIS were independent prognostic risk factors for children with APP. ALT combined with PCIS is an optimal predictive mortality scoring system for children with APP.
目前尚无适用于预测急性百草枯中毒（APP）患儿死亡率的评分系统。
优化APP患儿死亡率的预测评分系统。
本研究纳入了2010年1月1日至2020年1月1日期间共113例APP患儿。这些患者被分为存活组和非存活组。我们比较了两组之间的临床特征，并分析了独立的预后危险因素。采用kaplan-meier生存分析评估不同小儿危重疾病评分（PCIS）值患者的生存率。通过受试者工作特征曲线分析下的面积建立最佳评分系统。
总死亡率为23.4%。所有非存活者均在20天内死亡；48.1%（13/27）在3天内死亡，70.3%（19/27）在7天内死亡。与存活者相比，非存活者年龄更大，白细胞计数、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶、血清肌酐、血尿素氮、血糖和小儿早期预警评分更高，而血小板计数、白蛋白、血清钠（Na）和PCIS更低。ALT和PCIS是APP患儿独立的预后危险因素。分类为极危重症患者的患儿生存率（100%）低于分类为重症（60%）或非重症（6.7%）患者的患儿。ALT的特异性较高（96.51%），但敏感性较低（59.26%）。ALT与PCIS联合的敏感性和特异性较高，分别为92.59%和87.21%。ALT与PCIS联合时死亡率差异显著更高（受试者工作特征曲线下面积：0.937；95%CI：0.875-0.974；P<0.05）。
在我们的研究中，ALT和PCIS是APP患儿独立的预后危险因素。ALT与PCIS联合是APP患儿最佳的预测死亡率评分系统。
