3种儿童危重评分在重症监护室脓毒症患儿预后评估中的作用

目的探讨儿童危重病例评分(PCIS)、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)在儿童重症监护室(PICU)脓毒症患儿预后评估中的作用。方法回顾性分析2016年6月至2018年6月广东医科大学附属医院PICU收治的516例脓毒症患儿的临床资料,根据入院28 d结局将患儿分为存活组和死亡组。绘制受试者工作特征曲线(ROC曲线),采用ROC曲线下面积(AUC)评价PCIS、PELOD-2、P-MODS在PICU脓毒症患儿预后评估中的作用。结果存活组488例,死亡组28例。死亡组PCIS评分明显低于存活组86(82,88)分比89(84,92)分],PELOD-2及P-MODS评分均明显高于存活组PELOD-2:6.5(4.0,8.0)分比0(0,2.0)分,P-MODS:3(2,6)分比1(1,2)分],差异均有统计学意义(Z=3259.500、14.228、4.688,均P<0.05)。ROC曲线分析显示,PCIS、PELOD-2、P-MODS 3种评分评估PICU脓毒症患儿预后的AUC分别为0.761、0.916、0.761(Z=6.127、14.228、4.688,均P<0.05)。结论PCIS、PELOD-2、P-MODS均可较好地预测PICU脓毒症患儿的预后,尤以PELOD-2评分更加显著。

Effect of 3 pediatric scores of critical illness in prognostic evaluation of children with sepsis in intensive care units

Objective To investigate the effect of 3 pediatric scores of critical illness including Pediatric Critical Illness Score(PCIS),Pediatric Logistic Organ Dysfunction Score 2(PELOD-2),and Pediatric Multiple Organ Dysfunction Score(P-MODS)in estimating the prognosis of illness in children with sepsis in pediatric intensive care unit(PICU).Methods The data of 516 pediatric patients diagnosed as sepsis in PICU of Affiliated Hospital of Guangdong Medical University from June 2016 to June 2018 were retrospectively analyzed,and they were divided into survival group and death group according to the clinical outcome on the 28th day after admission.Then,the receiver operating characteristic(ROC)curve was plotted,and the efficiency of PCIS,PELOD-2 and P-MODS for predicting death was evaluated by the area under ROC curve(AUC).Results There were 488 pediatric patients survived,while 28 cases died during hospitalization.Compared with the survival group,the death group had a significantly lower PCIS score86(82,88)scores vs.89(84,92)scores],and significantly higher PELOD-2 and P-MODS scoresPELOD-2:6.5(4.0,8.0)scores vs.0(0,2.0)scores,P-MODS:3(2,6)scores vs.1(1,2)scores],and the differences were significant(Z=3259.500,14.228,4.688,all P<0.05).ROC curve analysis showed that the AUCs of PCIS,PELOD-2 and P-MODS for predicting prognosis of pediatric patients with sepsis in PICU were 0.761,0.916 and 0.761,respectively(Z=6.127,14.228,4.688,all P<0.05).Conclusions PCIS,PELOD-2 and P-MODS are effective and have good ability to assess the prognosis of pediatric patients with sepsis in the PICU.It seems that PELOD-2 is the most effective.