小儿危重病例评分在重症手足口病病情及预后评估中的作用

Role of Pediatric Critical Illness Score in evaluating severity and prognosis of severe hand-foot-mouth disease

摘要:

目的 探讨小儿危重病例评分(PCIS)在重症手足口病患儿预后及病情严重程度评估中的作用。方法 424 名重症手足口病患儿纳入该研究,其中存活390 例,死亡34 例。收集患儿PCIS 评分系统的相关生理参数及结局资料,通过受试者工作特征曲线(ROC)下面积(AUC)评估PCIS 评分系统对并发症和结局的分辨力。结果 存活组患儿PCIS 评分明显高于死亡组患儿(P<0.01)。424 名患儿中,通过PCIS 评分进行病情评估发现危重型病例仅26 名(6.1%)。PCIS 评分分辨是否发生肺水肿、肺出血和死亡的AUC 和95% 可信区间分别是0.74(0.66,0.82)、0.82(0.74,0.90)和0.83(0.75,0.92)。结论 PCIS 对重症手足口病并发症及预后有一定预测作用,但根据现有评分体系不能充分反映重症手足口病病情的严重程度。

Abstract:

Objective To investigate the role of Pediatric Critical Illness Score (PCIS) in evaluating the prognosis and severity of severe hand-foot-mouth disease (HFMD).Methods This study included 424 children with severe HFMD, consisting of 390 survivors and 34 deceased patients. Related physiological parameters and clinical data were collected for calculating PCIS scores. The area under receiver operating characteristic curve (AUC) was employed to assess the performance of PCIS in evaluating the complications and outcomes.Results The median of PCIS scores for survivors was higher than that for deceased patients (P<0.01). Of the 424 children with severe HFMD, only 26 (6.1%) had critical illness according to the severity assessment using PCIS. The AUC (95%CI) of PCIS was 0.74 (0.66, 0.82) in predicting pulmonary edema, 0.82 (0.74, 0.90) in predicting pulmonary hemorrhage, and 0.83 (0.75, 0.92) in predicting death.Conclusions PCIS can predict the complications and prognosis in children with severe HFMD. However, the existing scoring system of PCIS cannot fully assess the severity of HFMD.