新生儿序贯器官衰竭评估评分对极低/超低出生体重儿晚发型败血症死亡风险预测价值

doi:10.12372/jcp.2023.22e1395

摘要/Abstract

摘要：

目的探索新生儿序贯器官衰竭评估（nSOFA）评分对极低/超低出生体重儿晚发型败血症死亡风险的预测价值。方法回顾性分析2017 年1月至2021年12月收治的诊断为晚发型败血症的极低/超低出生体重儿的临床资料。在败血症确诊前后的5个时间点（T-24、T-12、T0、T12、T24）计算nSOFA评分，利用受试者工作特征（ROC）曲线分析nSOFA评分对患儿死亡风险的预测价值。结果纳入患儿135例，男66例、女69例，败血症诊断年龄为21.0（13.5~25.0）d。113例患儿存活，死亡22例（病死率16.3%）。存活组与死亡组之间在T-12、T0、T12、T24时间点nSOFA评分差异均有统计学意义（P<0.05）。ROC曲线分析显示，T-12、T0、T12、T24时间点nSOFA 评分预测极低/超低出生体重儿晚发型败血症死亡风险的灵敏度分别为59.1%、81.8%、93.2%、98.3%，特异度分别为63.6%、71.7%、73.7%、89.9%，曲线下面积分别为0.64、0.79、0.89、0.95。T24时nSOFA评分的灵敏度、特异度、曲线下面积均最大。结论 nSOFA评分对极低/超低出生体重儿晚发型败血症死亡风险具有预测价值，nSOFA评分越高，败血症患儿死亡风险越大。

关键词: 序贯器官衰竭评估, 晚发型败血症, 死亡, 极低/超低出生体重儿

Abstract:

Objective To explore the predictive value of neonatal sequential organ failure assessment (nSOFA) score for the death risk of late-onset sepsis in very/extremely low birth weight infants. Methods The clinical data of very/extremely low birth weight infants diagnosed with late-onset sepsis admitted from January 2017 to December 2021 were retrospectively analyzed. The nSOFA score was calculated at 5 time points (T-24, T-12, T0, T12, T24) before and after the diagnosis of sepsis. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of nSOFA score for mortality risk of children. Results A total of 135 children (66 boys and 69 girls) were included, and the age at diagnosis of sepsis was 21.0 (13.5-25.0) days. One hundred and thirteen children survived and 22 died (case fatality rate 16.3%). There were statistically significant differences in nSOFA scores between survival group and death group at T-12, T0, T12 and T24 time points (P<0.05). ROC curve analysis showed that the sensitivity of nSOFA score at T-12, T0, T12 and T24 to predict the death risk of late-onset sepsis in very/extremely low birth weight infants was 59.1%, 81.8%, 93.2% and 98.3%, and the specificity was 63.6%, 71.7%, 73.7% and 89.9%, respectively. The areas under the curve were 0.64, 0.79, 0.89 and 0.95, respectively. The sensitivity, specificity and area under the curve of nSOFA score were the largest at T24. Conclusions The nSOFA score has a predictive value for the risk of death from late-onset sepsis in very/extremely low birth weight infants. The higher the nSOFA score, the greater the risk of death from sepsis.

Key words: sequential organ failure assessment, neonatal late-onset sepsis, very/extremely low birth weight infant, death

郝庆飞, 陈静, 刘丽君, 李高攀, 陈浩明, 张静, 郭宏湘, 程秀永. 新生儿序贯器官衰竭评估评分对极低/超低出生体重儿晚发型败血症死亡风险预测价值[J]. 临床儿科杂志, 2023, 41(10): 670-674.

HAO Qingfei, CHEN Jing, LIU Lijun, LI Gaopan, CHEN Haoming, ZHANG Jing, GUO Hongxiang, CHENG Xiuyong. Predictive value of neonatal sequential organ failure assessment score for mortality risk of late-onset sepsis in very/extremely low birth weight infants[J]. Journal of Clinical Pediatrics, 2023, 41(10): 670-674.

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分值	机械通气与SpO₂/FiO₂	正性肌力药与静脉糖皮质激素应用	血小板计数/10⁹·L^-1
0分	无机械通气或 SpO₂/FiO₂≥300	未应用正性肌力药且未应用激素	≥150
1分	-	未应用正性肌力药但应用激素	100~149
2分	机械通气且SpO₂/FiO₂<300	1种正性肌力药但未应用激素	<100
3分	-	≥2种正性肌力药但未应用激素或1种正性肌力药但应用激素	<50
4分	机械通气且SpO₂/FiO₂<200	≥2种正性肌力药且应用激素	-
6分	机械通气且 SpO2/FiO2<150	-	-
8分	机械通气且SpO₂/FiO₂<100	-	-

项目	存活组（113例）	死亡组（22例）	统计量	P
胎龄($\bar{x}±s$)/周	30.3±1.8	30.1±2.1	0.28	0.780
出生体重[M(P₂₅~P₇₅)]/g	1 240.0(1 000.0~1 450.0)	1 240.0(957.0~1 400.0)	0.82	0.409
分娩方式为顺产[n(%)]	43(38.1)	8(36.4)	0.02	0.881
男性[n(%)]	55(48.7)	11(50.0)	0.15	0.909
败血症诊断日龄[M(P₂₅~P₇₅)]/d	18.0(14.0~25.0)	21.0(11.0~27.0)	0.02	0.981
病原体为G⁺[n(%)]	41(36.3)	7(31.8)	0.16	0.689

组别	例数	nSOFA评分
组别	例数	T-24	T-12	T0	T12	T24
存活组	113	1.0(0~2.0)	1.0(0~3.0)	2.0(1.0~4.0)	3.0(1.0~4.0)	3.0(2.0~4.0)
死亡组	22	1.5(0~3.0)	2.0(0~4.0)	4.0(4.0~5.0)	8.5(7.0~10.0)	10.0(9.0~11.0)
Z值		0.77	2.21	4.32	6.45	7.04
P		0.439	0.027	<0.001	<0.001	<0.001