5种评分方法在儿童急性呼吸窘迫综合征预后评估中的应用价值

doi:10.12372/jcp.2023.22e1197

Abstract

Abstract:

Objective To explore the application value of pediatric critical illness score (PCIS), pediatric risk of mortality (PRISM) Ⅲ score, pediatric sequential organ failure assessment (pSOFA) score, radiographic assessment of lung edema (RALE) score and acute lung injury score (LIS) in the prognosis evaluation of pediatric acute respiratory distress syndrome (pARDS). Methods The clinical data of children diagnosed with ARDS admitted to the pediatric intensive care unit (PICU) from January 2015 to December 2021 were retrospectively analyzed. Results A total of 80 ARDS children with sepsis and multiple organ dysfunction were enrolled, including 45 boys and 35 girls, and the median age was 12.5 (4.0-36.3) months. There were 50 patients in the survival group and 30 patients in the death group (16 died during hospitalization and 14 died after abandonment). Compared with the survival group, the death group had higher oxygenation index (OI), higher pSOFA and PRISM Ⅲ scores at transferring to PICU and diagnosing ARDS, higher RALE and LIS scores at diagnosing ARDS, and higher proportion of vasoactive substances application and blood transfusion. Furthermore, compared with the survival group, the death group had shorter total hospital stay, PICU stay and mechanical ventilation time, and lower proportion of intrapulmonary factors, PO₂/FiO₂ and PCIS scores. The differences were statistically significant (P<0.05). Compared with the group without underlying diseases, the scores of pSOFA, PRISM Ⅲ, RALE, and LIS were higher and the scores of PCIS were lower at the diagnosis of ARDS in the group with underlying diseases, the differences were statistically significant (P<0.05). The AUCs of PCIS, pSOFA, PRISM Ⅲ, RALE, and LIS at the diagnosis of ARDS in predicting the death of ARDS children were 0.73, 0.89, 0.83, 0.80 and 0.82, respectively. Hosmer-Lemeshow goodness of fit test showed that PCIS had the best fitting effect between predicted mortality and actual mortality (χ²=4.16, P=0.656). Conclusions PCIS, pSOFA, PRISM Ⅲ, RALE and LIS scores all have good predictive ability for the prognosis of children with ARDS, and pSOFA score had the highest predictive value. PCIS had the best fitting effect between predicted mortality and actual mortality.

Key words: acute respiratory distress syndrome, clinical score, prognosis evaluation, child

QIAO Junying, ZHANG Luodan, LI Fan, ZHAO Jianchuang, GUO Shanshan, ZHANG Jingpo. The application value of 5 scoring methods in the prognosis evaluation of acute respiratory distress syndrome in children[J].Journal of Clinical Pediatrics, 2023, 41(6): 442-449.

Figures/Tables 4

References 34

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项目	存活组(n=50)	死亡组(n=30)	统计量	P
年龄[M(P₂₅~P₇₅)]/月	14.0(4.0~37.5)	11.5(4.0~30.0)	Z=0.14	0.885
男性[n(%)]	28(56.0)	17(56.7)	χ²=0.00	0.954
体重[M(P₂₅~P₇₅)]/kg	9.4(5.0~15.0)	8.0(5.2~12.3)	Z=0.27	0.785
收缩压(x±s)/mmHg	97.0±13.8	91.0±15.6	t=1.68	0.096
总住院时间[M(P₂₅~P₇₅)]/d	23.0(16.0~39.0)	13.0(7.3~16.8)	Z=3.92	<0.001
PICU住院时间[M(P₂₅~P₇₅)]/d	21.0(15.0~27.8)	5.0(2.0~12.0)	Z=5.53	<0.001
机械通气时间[M(P₂₅~P₇₅)]/d	9.0(7.0~13.3)	5.5(3.0~11.5)	Z=3.23	0.001
有创机械通气[n(%)]	47(94.0)	30(100)	χ²=0.58	0.447
肺内/肺外因素	44/6	17/13	χ²=10.17	0.001
合并基础疾病[n(%)]	15(30.0)	21(70.0)	χ²=12.12	<0.001
使用血管活性药物[n(%)]	14(28.0)	25(83.3)	χ²=22.98	<0.001
输血[n(%)]	22(44.0)	23(76.7)	χ²=8.13	0.004
丙种球蛋白治疗[n(%)]	43(86.0)	29(96.7)	χ²=1.33	0.248
病情程度(轻/中/重)	29/15/6	0/15/15	χ²=29.71	<0.001
PO₂/FiO₂[M(P₂₅~P₇₅)]/mmHg	187.5(123.8~216.0)	95.5(76.5~120.0)	Z=4.98	<0.001
氧合指数OI[M(P₂₅~P₇₅)]	6.0(5.0~11.2)	15.7(12.2~24.7)	Z=5.06	<0.001
白细胞计数[M(P₂₅~P₇₅)]/×10⁹·L^-1	8.5(4.7~13.8)	14.2(6.3~24.3)	Z=1.73	0.084
转入PICU时[M(P₂₅~P₇₅)]/分
PCIS评分	84.0(80.0~86.5)	82.0(74.5~88.0)	Z=1.32	0.188
pSOFA评分	3.0(3.0~5.3)	7.0(4.0~9.0)	Z=3.93	<0.001
PRISM Ⅲ评分	3.0(2.0~5.0)	7.5(2.0~13.0)	Z=2.82	0.005
ARDS发生时[M(P₂₅~P₇₅)]/分
RALE评分	20.0(16.0~24.0)	27.0(24.0~28.3)	Z=4.51	<0.001
LIS评分	2.5(2.3~2.8)	3.0(2.8~3.3)	Z=4.87	<0.001
PCIS评分	84.0(80.0~86.0)	76.0(70.0~84.0)	Z=3.38	0.001
pSOFA评分	3.0(3.0~6.0)	9.0(7.8~11.3)	Z=5.82	<0.001
PRISM Ⅲ评分	3.0(2.0~6.0)	10.0(7.0~14.5)	Z=4.87	<0.001

项目	不合并基础疾病组(n=44)	合并基础疾病组(n=36)	Z值	P
PCIS评分	84.0(80.0~86.0)	79.0(70.5~82.0)	3.44	0.001
pSOFA评分	3.0(3.0~6.0)	9.0(5.3~10.8)	5.01	<0.001
PRISMⅢ评分	3.0(2.0~6.0)	9.5(5.3~14.0)	5.29	<0.001
RALE评分	20.0(16.0~24.0)	27.0(20.0~27.8)	3.39	0.001
LIS评分	2.5(2.3~2.8)	2.9(2.8~3.0)	4.17	<0.001

评分	最佳截断值	AUC(95%CI)	P	灵敏度/%	特异度/%
PCIS	77.0	0.73(0.61~0.85)	0.001	53.3	86.0
pSOFA	7.5	0.89(0.82~0.96)	<0.001	76.7	82.0
PRISMⅢ	5.5	0.83(0.72~0.94)	<0.001	83.3	72.0
RALE	23.0	0.80(0.70~0.90)	<0.001	80.0	70.0
LIS	2.6	0.82(0.73~0.91)	<0.001	93.3	62.0

例数	存活		死亡		例数	存活		死亡
例数	观察值	预测值	观察值	预测值	例数	观察值	预测值	观察值	预测值
PCIS					pSOFA
13	11	10.9	2	2.1	8	8	7.6	0	0.4
7	4	5.6	3	1.4	18	18	16.5	0	1.5
14	11	10.6	3	3.4	6	5	5.2	1	0.8
7	6	5.0	1	2.1	8	5	6.5	3	1.5
11	8	7.1	3	3.9	8	5	5.5	3	2.5
9	4	5.0	5	4.0	4	2	1.9	2	2.1
8	4	3.5	4	4.5	13	5	4.7	8	8.3
11	2	2.3	9	8.7	9	1	1.8	8	7.2
					6	1	0.2	5	5.8
PRISM Ⅲ					RALE
9	6	8.2	3	0.8	9	8	8.5	1	0.5
10	10	8.7	0	1.3	6	6	5.4	0	0.6
11	11	9.1	0	1.9	9	8	7.7	1	1.3
11	9	8.3	2	2.7	13	9	10.2	4	2.8
8	7	5.4	1	2.6	4	4	2.8	0	1.2
10	3	5.6	7	4.4	10	5	5.7	5	4.3
8	2	3.2	6	4.8	1	0	0.5	1	0.5
8	2	1.3	6	6.7	16	8	6.3	8	9.7
5	0	0.2	5	4.8	12	2	2.9	10	9.1
LIS
4	4	3. 9	0	0.1
14	14	12.9	0	1.1
15	13	12.2	2	2.8
22	11	13.8	11	8.2
13	4	5.1	9	7.9
12	4	2.1	8	9.9

The application value of 5 scoring methods in the prognosis evaluation of acute respiratory distress syndrome in children

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