Zhao Chun, Xin Mei-Yun, Li Jing, Zhao Jin-Fang, Wang Yu-Juan, Wang Wei, Gao Qian, Chen Jie, Wang Qi-Wei, Jin You-Peng
Department of Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China.
Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining 272129, China.
World J Emerg Med. 2022;13(4):259-265. doi: 10.5847/wjem.j.1920-8642.2022.060.
The latest sepsis definition includes both infection and organ failure, as evidenced by the sequential organ failure assessment (SOFA) score. However, the applicability of the pediatric SOFA score (pSOFA) is not yet determined. This study evaluated the effectiveness of both pSOFA and system inflammatory reaction syndrome (SIRS) scores in predicting sepsis-related pediatric deaths.
This is a retrospective multi-center cohort study including hospitalized patients <18 years old with diagnosed or not-yet-diagnosed infections. Multivariate analyses were carried out to evaluate risk factors for in-hospital mortality. According to Youden index (YI), three sub-categories of pSOFA were screened out and a new simplified pSOFA score (spSOFA) was formed. The effectiveness and accuracy of prediction of pSOFA, SIRS and spSOFA was retrieved from the area under the receiver operating characteristic curve (AUROC) and Delong's test.
A total of 1,092 participants were eligible for this study, and carried a 23.4% in-hospital mortality rate. The 24-h elevated pSOFA score (24 h-pSOFA), bloodstream infection, and mechanical ventilation (MV) requirement were major risk factors associated with sepsis-related deaths. The AUROC analysis confirmed that the spSOFA provided good predictive capability in sepsis-related pediatric deaths, relative to the 24 h-pSOFA and SIRS.
The pSOFA score performed better than SIRS in diagnosing infected children with high mortality risk. However, it is both costly and cumbersome. We, therefore, proposed spSOFA to accurately predict patient outcome, without the disadvantages. Nevertheless, additional investigations, involving a large sample population, are warranted to confirm the conclusion of this study.
最新的脓毒症定义包括感染和器官功能衰竭，序贯器官衰竭评估（SOFA）评分可证明这一点。然而，儿童SOFA评分（pSOFA）的适用性尚未确定。本研究评估了pSOFA和全身炎症反应综合征（SIRS）评分在预测脓毒症相关儿童死亡中的有效性。
这是一项回顾性多中心队列研究，纳入了年龄<18岁、已确诊或未确诊感染的住院患者。进行多变量分析以评估院内死亡的危险因素。根据约登指数（YI），筛选出pSOFA的三个亚类，形成了一个新的简化pSOFA评分（spSOFA）。通过受试者操作特征曲线下面积（AUROC）和德龙检验来评估pSOFA、SIRS和spSOFA预测的有效性和准确性。
共有1092名参与者符合本研究条件，院内死亡率为23.4%。24小时pSOFA评分升高（24 h-pSOFA）、血流感染和机械通气（MV）需求是与脓毒症相关死亡相关的主要危险因素。AUROC分析证实，相对于24 h-pSOFA和SIRS，spSOFA在脓毒症相关儿童死亡中具有良好的预测能力。
在诊断具有高死亡风险的感染儿童时，pSOFA评分比SIRS表现更好。然而，它既昂贵又繁琐。因此，我们提出了spSOFA，以准确预测患者预后，且无上述缺点。尽管如此，仍需要进行涉及大量样本的进一步研究来证实本研究的结论。
