Algren J T, Lal S, Cutliff S A, Richman B J
Department of Anesthesiology, Baylor College of Medicine, Houston, TX.
Crit Care Med. 1993 Mar;21(3):447-52. doi: 10.1097/00003246-199303000-00024.
To develop a rapid and sensitive method for identification of patients at risk for organ system failure and death due to acute meningococcal infection, and to evaluate the reliability of the Pediatric Risk of Mortality score in predicting mortality rates from acute meningococcal infection.
A prospective study which followed a retrospective analysis.
The Emergency Department and pediatric intensive care unit (ICU) of a university-affiliated children's hospital.
The hospital records of 86 pediatric patients with acute meningococcal infection during a 5-yr period (group 1) were reviewed. Twenty-two ICU patients (group 2) were then prospectively evaluated, and the occurrence rate of organ system failure was compared with that rate predicted by the model developed from the analysis of group 1.
The occurrence of prognostic factors was compared with the development of organ system failure and death by Fisher's exact test and logistic regression analysis for patients in group 1. The mortality rates for groups 1 and 2 were compared with those rates that were predicted by the use of the Pediatric Risk of Mortality score.
Eighteen of 86 patients in group 1 developed organ system failure, and seven (8.1%) patients died. Logistic regression analysis found that the combination of circulatory insufficiency, peripheral WBC counts of < 10,000 cells/mm3, and coagulopathy best predicted organ system failure. Ten of 22 patients in group 2 developed organ system failure, and two died. All patients with organ system failure exhibited > or = 1 of three identified prognostic factors. The probability of organ system failure occurring was > .5 for nine of ten patients with organ system failure. A total of nine patients in groups 1 and 2 developed multiple organ system failure, and all nine patients died. Based on Pediatric Risk of Mortality scoring, the mortality risk for nonsurvivors ranged from 27% to 94%, compared with 1% to 48% for survivors. The overall mortality rate was consistent with that rate predicted by the Pediatric Risk of Mortality scoring system.
Patients with acute meningococcal infection who exhibit signs of circulatory insufficiency, a peripheral WBC count of < 10,000 cells/mm3, or a coagulopathy have a high probability of developing organ system failure. Death is highly probable when multiple organ system failure develops, and the overall mortality rate is accurately predicted by the Pediatric Risk of Mortality score.
开发一种快速且灵敏的方法，用于识别因急性脑膜炎球菌感染而有器官系统衰竭和死亡风险的患者，并评估儿童死亡风险评分在预测急性脑膜炎球菌感染死亡率方面的可靠性。
一项前瞻性研究，其之前有回顾性分析。
一所大学附属医院的急诊科和儿科重症监护病房（ICU）。
回顾了5年期间86例急性脑膜炎球菌感染儿科患者的医院记录（第1组）。然后对22例ICU患者（第2组）进行前瞻性评估，并将器官系统衰竭的发生率与通过对第1组分析得出的模型预测的发生率进行比较。
通过Fisher精确检验和逻辑回归分析，比较第1组患者预后因素的出现情况与器官系统衰竭和死亡的发生情况。将第1组和第2组的死亡率与使用儿童死亡风险评分预测的死亡率进行比较。
第1组的86例患者中有18例发生器官系统衰竭，7例（8.1%）患者死亡。逻辑回归分析发现，循环功能不全、外周血白细胞计数<10,000个/mm³和凝血病的组合最能预测器官系统衰竭。第2组的22例患者中有10例发生器官系统衰竭，2例死亡。所有发生器官系统衰竭的患者均表现出三种已确定预后因素中的≥1种。10例发生器官系统衰竭的患者中有9例发生器官系统衰竭的概率>.5。第1组和第2组共有9例患者发生多器官系统衰竭，且所有9例患者均死亡。根据儿童死亡风险评分，非幸存者的死亡风险为27%至94%，而幸存者为1%至48%。总体死亡率与儿童死亡风险评分系统预测的死亡率一致。
出现循环功能不全迹象、外周血白细胞计数<10,000个/mm³或凝血病的急性脑膜炎球菌感染患者发生器官系统衰竭的可能性很高。当发生多器官系统衰竭时，死亡可能性很大，儿童死亡风险评分能准确预测总体死亡率。
