探讨3种评分系统对儿童严重脓毒症预后的评估价值

Value of three scoring systems in evaluating the prognosis of children with severe sepsis

摘要:

目的 探讨儿童年龄适应性序贯器官衰竭评分（pSOFA）、儿童死亡危险评分（PRISM Ⅲ）、儿童危重病例评分（PCIS）在儿童严重脓毒症中的预测价值和使用价值，以期为临床工作提供借鉴。方法 分析收治的193例严重脓毒症患儿的临床资料，根据最终结局将患儿分为存活组（n=151）和死亡组（n=42）。根据入院24 h内各指标的最差值进行pSOFA、PRISM Ⅲ、PCIS评分。受试者工作特征曲线（ROC）分析各评分系统预测脓毒症死亡风险的效能，平滑曲线拟合分析各评分系统的相关性和阈值效应，决策曲线分析（DCA）各评分系统的使用价值。结果 ROC分析示PCIS与pSOFA预测价值相当（P=0.182），PRISM Ⅲ与pSOFA预测价值相当（P=0.210），但PRISM Ⅲ优于PCIS （P=0.045）。3种评分系统与预后的拟合程度为PRISM Ⅲ > pSOFA > PCIS。DCA分析显示当严重脓毒症患儿死亡风险分别为0.4和0.6时，使用3种评分系统作为紧急干预决策依据，患儿的标准净受益（SNB）为SNB （pSOFA） > SNB （PRISM Ⅲ） > SNB （PCIS）。结论 3种评分系统对严重脓毒症患儿预后均有一定的预测价值，作为临床决策辅助工具可使患儿从中受益，pSOFA优于PRISM Ⅲ和PCIS。

Abstract:

Objective To study the predictive value of Pediatric Age-adapted Sequential Organ Failure Assessment Score (pSOFA), Pediatric Risk of Mortality Score Ⅲ (PRISM Ⅲ), and Pediatric Critical Illness Score (PCIS) in children with severe sepsis. Methods A retrospective analysis was performed for the clinical data of 193 hospitalized children with severe sepsis. According to the final outcome, these children were divided into a survival group with 151 children and a death group with 42 children. The scores of pSOFA, PRISM Ⅲ, and PCIS were determined according to the worst values of each index within 24 hours after admission. The receiver operating characteristic (ROC) curve was used to analyze the efficiency of each scoring system in predicting the risk of death due to sepsis. Smooth curve fitting was used to analyze the correlation between the three scoring systems and the threshold effect of each scoring system. Decision curve analysis (DCA) was used to evaluate the application value of each scoring system. Results The ROC analysis showed that PCIS and pSOFA had a similar predictive value (P=0.182) and that PRISM Ⅲ and pSOFA had a similar predictive value (P=0.210), while PRISM Ⅲ had a better predictive value than PCIS (P=0.045). PRISM Ⅲ had the highest degree of fitting with prognosis, followed by pSOFA and PCIS. The DCA analysis showed that when the risk of death was 0.4 and 0.6 in children with severe sepsis and the three scoring systems were used as the basis for emergency intervention decision-making, pSOFA achieved the highest standardized net benefit, followed by PRISM Ⅲ and PCIS. Conclusions All three scoring systems have a certain value in predicting the prognosis of children with severe sepsis, and pSOFA has a better value than PRISM Ⅲ and PCIS.