儿童癌症重症患儿中儿科死亡风险评分IV与儿科死亡率指数3的比较性能：一项前瞻性观察研究。
Comparative Performance of Pediatric Risk of Mortality IV and Pediatric Index of Mortality 3 in Critically Ill Children with Cancer: A Prospective Observational Study.
作者信息
Kalvit Kushal R, Bhosale Shilpushp J, Pulinilkunnathi Jacob G, Vijayakumaran Swapna C, Shrivastava Anjana M, Kulkarni Atul P
机构信息
Guys and St Thomas' NHS Foundation Trust, London, United Kingdom.
Department of Anesthesiology, Critical Care and Pain, Division of Critical Care Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
出版信息
Indian J Crit Care Med. 2025 Jun;29(6):486-491. doi: 10.5005/jp-journals-10071-24979. Epub 2025 Jun 5.
BACKGROUND AND AIMS
In pediatric critical care, pediatric risk of mortality (PRISM) and pediatric index of mortality (PIM) scoring systems are the most widely used severity of illness scoring systems. The current versions of these scoring systems (PRISM IV and PIM 3) have not been validated in critically ill oncology patients. The aim of this study was to evaluate the comparative performance of PRISM IV and PIM 3 in critically ill children with cancer.
PATIENTS AND METHODS
About 415 critically ill pediatric patients were recruited at a single-center, mixed medical-surgical ICU in a prospective observational study. Patients with an expected ICU stay of greater than 24 h were included. Demographic, physiological, and laboratory parameters required to calculate the PRISM IV and PIM 3 scores were collected; laboratory data from 2 hours prior to 4 hours after admission, and physiological data within 4 hours of admission were collected. The worst value was considered for calculating the scores. Both scores and their predicted mortality risk were calculated using online calculators.
RESULTS
The mortality at ICU discharge and at hospital discharge was 32.7% and 36.1%, respectively. For the prediction of hospital mortality, the AUROC for PRISM IV score was 0.71and the PIM 3 estimated mortality (%) was 0.78, respectively. There was a statistically significant positive correlation between the PRISM IV score and PIM 3 estimated mortality (%) with the hospital mortality. The logistic model for PRISM IV score also passed the goodness-of-fit test indicating a good model fit. The goodness-of-fit test for the PIM 3 model suggests that the model may not fit the data well and may require further investigation or improvement.
CONCLUSIONS
Both PRISM IV and PIM 3 scores showed acceptable discriminative ability between survivors and non-survivors in the critically ill pediatric oncology population. However, only the PRISM IV score showed good calibration in the prediction of survival.
HOW TO CITE THIS ARTICLE
Kalvit KR, Bhosale SJ, Pulinilkunnathi JG, Vijayakumaran SC, Shrivastava AM, Kulkarni AP. Comparative Performance of Pediatric Risk of Mortality IV and Pediatric Index of Mortality 3 in Critically Ill Children with Cancer: A Prospective Observational Study. Indian J Crit Care Med 2025;29(6):486-491.
背景与目的
在儿科重症监护中，儿科死亡风险（PRISM）和儿科死亡指数（PIM）评分系统是应用最广泛的疾病严重程度评分系统。这些评分系统的当前版本（PRISM IV和PIM 3）尚未在重症肿瘤患者中得到验证。本研究的目的是评估PRISM IV和PIM 3在重症癌症患儿中的比较性能。
患者与方法
在一项前瞻性观察性研究中，于一家单中心、综合内科-外科重症监护病房招募了约415名重症儿科患者。纳入预期重症监护病房停留时间超过24小时的患者。收集计算PRISM IV和PIM 3评分所需的人口统计学、生理学和实验室参数；收集入院前2小时至入院后4小时的实验室数据以及入院后4小时内的生理学数据。计算评分时考虑最差值。使用在线计算器计算评分及其预测的死亡风险。
结果
重症监护病房出院时和医院出院时的死亡率分别为32.7%和36.1%。对于医院死亡率的预测，PRISM IV评分的受试者工作特征曲线下面积（AUROC）为0.71，PIM 3估计死亡率（%）的AUROC为0.78。PRISM IV评分与PIM 3估计死亡率（%）与医院死亡率之间存在统计学显著正相关。PRISM IV评分的逻辑模型也通过了拟合优度检验，表明模型拟合良好。PIM 3模型的拟合优度检验表明该模型可能与数据拟合不佳，可能需要进一步研究或改进。
结论
PRISM IV和PIM 3评分在重症儿科肿瘤患者的幸存者和非幸存者之间均显示出可接受的鉴别能力。然而，只有PRISM IV评分在生存预测中显示出良好的校准。
如何引用本文
Kalvit KR, Bhosale SJ, Pulinilkunnathi JG, Vijayakumaran SC, Shrivastava AM, Kulkarni AP. 儿科死亡风险IV与儿科死亡指数3在重症癌症患儿中的比较性能：一项前瞻性观察性研究。《印度重症监护医学杂志》2025；29(6):486 - 491。
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