Arslan Gazi, Besci Tolga, Özdemir Göktuğ, Evren Gültaç, Ilgaz Tüzen Hande, Prencuva Pınar, Turan Bengisu, Benligül Ebru Melek
Department of Pediatrics, Division of Pediatric Intensive Care, Faculty of Medicine, Dokuz Eylül University, Konak 35220, Turkey.
Children (Basel). 2023 Oct 26;10(11):1731. doi: 10.3390/children10111731.
The accurate prediction of the prognosis for critically ill children is crucial, with the Pediatric Index of Mortality (PIM) and Pediatric Risk of Mortality (PRISM) being extensively utilized for this purpose. Albumin, C-reactive protein (CRP), and lactate levels, which are indicative of inflammation and circulatory status in critically ill children, have not been incorporated into existing scoring systems. This retrospective cohort study evaluated the association between biological markers and the clinical outcomes in children with critical illnesses. PRISM-4 and PIM-3 death probability (DP), albumin, lactate, CRP, and CRP/albumin ratio were recorded upon admission. The accuracy of the indexes in predicting mortality were assessed by calculating the area under the curve (AUC). There were 942 patients included and the 28-day mortality rate was 7.9%. The AUC for PRISM-4, PIM-3, CRP, CRP/albumin ratio, albumin, and lactate were 0.923, 0.896, 0.798, 0.795, 0.751, 0.728, respectively. The findings in the subgroup analysis of septic patients were similar to those found in the overall population. Although CRP, CRP/albumin ratio, albumin, and lactate levels are all linked to mortality in children, CRP and the CRP/albumin ratio have lower predictive values than albumin and lactate. Incorporation of albumin and lactate into scoring systems will improve predictability.
准确预测危重症儿童的预后至关重要,为此广泛使用了儿童死亡率指数(PIM)和儿童死亡风险指数(PRISM)。白蛋白、C反应蛋白(CRP)和乳酸水平可反映危重症儿童的炎症和循环状态,但尚未纳入现有的评分系统。这项回顾性队列研究评估了生物标志物与危重症儿童临床结局之间的关联。入院时记录PRISM-4和PIM-3死亡概率(DP)、白蛋白、乳酸、CRP以及CRP/白蛋白比值。通过计算曲线下面积(AUC)评估各指标预测死亡率的准确性。共纳入942例患者,28天死亡率为7.9%。PRISM-4、PIM-3、CRP、CRP/白蛋白比值、白蛋白和乳酸的AUC分别为0.923、0.896、0.798、0.795、0.751、0.728。脓毒症患者亚组分析的结果与总体人群相似。虽然CRP、CRP/白蛋白比值、白蛋白和乳酸水平均与儿童死亡率相关,但CRP和CRP/白蛋白比值的预测价值低于白蛋白和乳酸。将白蛋白和乳酸纳入评分系统将提高预测能力。