院内期望结局排名量表与出院后健康相关生活质量的相关性：儿科脓毒症评估后生活的二次分析。
Association of an In-Hospital Desirability of Outcomes Ranking Scale With Postdischarge Health-Related Quality of Life: A Secondary Analysis of the Life After Pediatric Sepsis Evaluation.
机构信息
Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
Department of Pediatrics, University of Utah, Salt Lake City, UT.
出版信息
Pediatr Crit Care Med. 2024 Jun 1;25(6):528-537. doi: 10.1097/PCC.0000000000003470. Epub 2024 Feb 14.
OBJECTIVES
To develop a desirability of outcome ranking (DOOR) scale for use in children with septic shock and determine its correlation with a decrease in 3-month postadmission health-related quality of life (HRQL) or death.
DESIGN
Secondary analysis of the Life After Pediatric Sepsis Evaluation prospective study.
SETTING
Twelve U.S. PICUs, 2013-2017.
PATIENTS
Children (1 mo-18 yr) with septic shock.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
We applied a 7-point pediatric critical care (PCC) DOOR scale: 7: death; 6: extracorporeal life support; 5: supported by life-sustaining therapies (continuous renal replacement therapy, vasoactive, or invasive ventilation); 4: hospitalized with or 3: without organ dysfunction; 2: discharged with or 1: without new morbidity to patients by assigning the highest applicable score on specific days post-PICU admission. We analyzed Spearman rank-order correlations (95% CIs) between proximal outcomes (PCC-DOOR scale on days 7, 14, and 21, ventilator-free days, cumulative 28-day Pediatric Logistic Organ Dysfunction-2 (PELOD-2) scores, and PICU-free days) and 3-month decrease in HRQL or death. HRQL was measured by Pediatric Quality of Life Inventory 4.0 or Functional Status II-R for patients with developmental delay. Patients who died were assigned the worst possible HRQL score. PCC-DOOR scores were applied to 385 patients, median age 6 years (interquartile range 2, 13) and 177 (46%) with a complex chronic condition(s). Three-month outcomes were available for 245 patients (64%) and 42 patients (17%) died. PCC-DOOR scale on days 7, 14, and 21 demonstrated fair correlation with the primary outcome (-0.42 [-0.52, -0.31], -0.47 [-0.56, -0.36], and -0.52 [-0.61, -0.42]), similar to the correlations for cumulative 28-day PELOD-2 scores (-0.51 [-0.59, -0.41]), ventilator-free days (0.43 [0.32, 0.53]), and PICU-free days (0.46 [0.35, 0.55]).
CONCLUSIONS
The PCC-DOOR scale is a feasible, practical outcome for pediatric sepsis trials and demonstrates fair correlation with decrease in HRQL or death at 3 months.
目的
开发一种适用于脓毒性休克儿童的理想结局（DOOR）评分量表，并确定其与 3 个月后入院相关健康相关生活质量（HRQL）下降或死亡的相关性。
设计
前瞻性研究 Life After Pediatric Sepsis Evaluation 的二次分析。
地点
美国 12 个 PICUs，2013-2017 年。
患者
患有脓毒性休克的儿童（1 个月至 18 岁）。
干预措施
无。
测量和主要结果
我们应用了 7 分小儿重症监护（PCC）DOOR 量表：7：死亡；6：体外生命支持；5：通过生命支持治疗（连续肾脏替代治疗、血管活性药物或有创通气）维持；4：住院伴有或 3：无器官功能障碍；2：出院伴有或 1：无新发病。通过在 PICU 入院后特定日期分配最高适用分数，为患者分配最高适用分数。我们分析了近结局（PICU 入院后第 7、14 和 21 天的 PCC-DOOR 量表、无呼吸机天数、累积 28 天儿科逻辑器官功能障碍评分-2（PELOD-2）和 PICU 无天数）与 3 个月内 HRQL 下降或死亡的 Spearman 秩相关系数（95%CI）。HRQL 通过儿科生活质量清单 4.0 或发育迟缓患者的功能状态 II-R 进行测量。死亡患者被分配最差的 HRQL 评分。PCC-DOOR 评分适用于 385 名患者，中位年龄为 6 岁（四分位距 2，13），177 名（46%）患有复杂的慢性疾病。245 名患者（64%）可获得 3 个月的结局，42 名患者（17%）死亡。第 7、14 和 21 天的 PCC-DOOR 量表与主要结局呈中度相关（-0.42[-0.52，-0.31]、-0.47[-0.56，-0.36]和-0.52[-0.61，-0.42]），与累积 28 天的 PELOD-2 评分相似（-0.51[-0.59，-0.41]）、无呼吸机天数（0.43[0.32，0.53]）和 PICU 无天数（0.46[0.35，0.55]）。
结论
PCC-DOOR 量表是儿科脓毒症试验的一种可行、实用的结局，与 3 个月时 HRQL 下降或死亡呈中度相关。
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