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51
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中华危重病急救医学 2018 年 1 月第 30 卷第 1 期 Chin Crit Care Med,January 2018,Vol.30,No.1
·论著·
4 种小儿危重死亡评分对危重患儿
死亡风险的预测价值
张丽丹 黄慧敏 程玉才 徐玲玲 黄雪琼 裴瑜馨 唐雯 覃肇源
510080 广东广州
,
中山大学附属第一医院儿科 ICU
(
张丽丹
、
黄慧敏
、
程玉才
、
徐玲玲
、
黄雪琼
、
裴瑜馨
、
唐雯
),
儿科
(
覃肇源
)
通讯作者
:
覃肇源
,
Email
:
zqqinzhaoyuan@163.com
DOI:10.3760/cma.j.issn.2095-4352.2018.01.010
【
摘要
】
目的 探讨小儿危重病例评分(PCIS)、儿童死亡风险评分Ⅲ(PRISM Ⅲ)、儿童器官功能障碍评
分 2(PELOD-2)、儿童多器官功能障碍评分(P-MODS)对危重患儿死亡风险的预测价值。方法 回顾性分析
2012 年 8 月至 2017 年 5 月入住中山大学附属第一医院儿童重症加强治疗病房(PICU)的 461 例危重患儿的
临床资料,收集所有患儿的性别、年龄、基础疾病、PICU 住院时间;根据住院期间临床结局将患儿分为存活组
和死亡组。记录两组患儿入 PICU 后 24 h 内 PCIS、PRISM Ⅲ、PELOD-2、P-MODS 相关生理学参数并评分;绘
制受试者工作特征曲线(ROC),采用 ROC 曲线下面积(AUC)评估 PCIS、PRISM Ⅲ、PELOD-2、P-MODS 对死
亡的预测能力;采用 Hosmer-Lemeshow 拟合优度检验,评估各项评分系统预测病死率与实际病死率的拟合度。
结果 461 例危重患儿中 35 例因资料严重缺失、住院未超过 24 h、入院 8 h 内死亡而被排除,最终 426 例患
儿纳入分析 ;住院期间存活 355 例,死亡 71 例,病死率 16.7%。两组患儿性别、年龄、基础疾病及 PICU 住院
时间比较差异无统计学意义;死亡组 PCIS 评分明显低于存活组〔分:80(76,88)比 86(80,92)〕,PRISM Ⅲ、
PELOD-2 及 P-MODS 评分均明显高于存活组〔PRISM Ⅲ(分):16(13,22)比 12(10,15),PELOD-2(分):6(5,9)
比 4(2,5),P-MODS(分):6(4,9)比 3(2,6),均 P<0.01〕。ROC 曲线分析显示,PCIS、PRISM Ⅲ、PELOD-2
和 P-MODS 评分预测危重患儿死亡的 AUC 分别为 0.649、0.731、0.773、0.747。Hosmer-Lemeshow 拟合优度检
验结果显示,PCIS 预测病死率与实际病死率的拟合效果最好(
χ
2
=7.573,P=0.476);PELOD-2、P-MODS 预
测病死率与实际病死率的拟合效果尚可(
χ
1
2
=9.551,P
1
=0.145;
χ
2
2
=10.343,P
2
=0.111);而 PRISM Ⅲ预
测病死率与实际病死率拟合效果不佳(
χ
2
=43.549,P<0.001)。结论 PRISM Ⅲ、PELOD-2、P-MODS 均可
较好预测危重患儿的预后,准确评估病情 ;PCIS 的预测病死率与实际病死率一致性最好,其次是 PELOD-2、
P-MODS,而 PRISM Ⅲ的一致性不佳。
【
关键词
】
危重评分; 死亡评分; 预测; 病死率
基金项目 :国家临床重点专科建设项目(2011-872);广东省科技计划项目(2013B021800276);广东省广
州市科技计划项目(201510010148)
Predictive value of four pediatric scores of critical illness and mortality on evaluating mortality risk in
pediatric critical patients Zhang Lidan, Huang Huimin, Cheng Yucai, Xu Lingling, Huang Xueqiong, Pei Yuxin,
Tang Wen, Qin Zhaoyuan
Pediatric ICU, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong, China (Zhang LD,
Huang HM, Cheng YC, Xu LL, Huang XQ, Pei YX, Tang W); Department of Pediatrics, the First Affiliated Hospital,
Sun Yat-Sen University, Guangzhou 510080, Guangdong, China (Qin ZY)
Corresponding author: Qin Zhaoyuan, Email: zqqinzhaoyuan@163.com
【
Abstract
】
Objective To assess the performance of pediatric clinical illness score (PCIS), pediatric risk of
mortality score Ⅲ (PRISM Ⅲ ), pediatric logistic organ dysfunction score 2 (PELOD-2), and pediatric multiple organ
dysfunction score (P-MODS) in predicting mortality in critically ill pediatric patients. Methods The data of critically
ill pediatric patients admitted to Pediatric Intensive Care Unit (PICU) of First Affiliated Hospital of Sun Yat-Sen
University from August 2012 to May 2017 were retrospectively analyzed. The gender, age, basic diseases, the length of
PICU stay were collected. The children were divided into survival group and non-survival group according to the clinical
outcome during hospitalization. The variables of PCIS, PRISM Ⅲ , PELOD-2, and P-MODS were collected and scored.
Receiver operating characteristic (ROC) curve was plotted, the efficiency of PCIS, PRISM Ⅲ , PELOD-2, and P-MODS
for predicting death were evaluated by the area under ROC curve (AUC). Hosmer-Lemeshow goodness of fit test was used
to evaluate the fitting degree of each scoring system to predict the mortality and the actual mortality. Results Of 461
critically ill children, 35 children were excluded because of serious data loss, hospital stay not exceeding 24 hours, and
death within 8 hours after admission. Finally, a total of 426 pediatric patients were enrolled in this study. 355 pediatric
patients were survived, while 71 were not survived during hospitalization, with the mortality of 16.7%. There was no
significant difference in gender, age, underlying diseases or length of PICU stay between the two groups. PCIS score
万方数据