A bedside prediction-scoring model for late-onset neonatal sepsis.
A bedside prediction-scoring model for late-onset neonatal sepsis.
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DOI：
10.1038/sj.jp.7211404
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发表时间：
2005-12-01
期刊：
影响因子：
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通讯作者：
Supapanachart, Sarayut
中科院分区：
文献类型：
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作者：
Okascharoen, Chusak;Sirinavin, Sayomporn;Supapanachart, Sarayut
目的：本研究开始时，床旁预测晚发型新生儿败血症（LNS）的工具不足。目的是开发和验证一个简单的预测评分模型LNS定义为文化证实败血症发生后72 hours birth.METHODS：这项研究是在曼谷的一所大学医院进行的。推导阶段包括1870例新生儿病历，随机选择1998年至2000年期间住院时间>72小时的9347例新生儿病历，其中1824例可用。总共有100名新生儿临床疑似败血症，17名已证实LNS。验证阶段包括2002年7月至2003年6月期间73例疑似败血症的新生儿和25例LNS。采用考克斯比例风险模型的加权系数和受试者工作特征（ROC）曲线分析。结果：LNS的发病密度为17/11355（1.5/1000）人·天。开发了评分模型，包括以下内容：低血压（评分4）、体温异常（评分3）、呼吸功能不全（评分2）、中性粒细胞带状分数>1%（评分2）、血小板计数7天;评分2或4）。在两个阶段中，预测疑似败血症新生儿LNS的ROC曲线下面积分别为0.85和0.80（p=0.436）。评分0 ~ 3分的患者发生LNS的平均概率约为0.10（低危），4 ~ 6分的患者为0.50（中危），7分以上的患者为0.70（高危）。结论：建立了一个简单的LNS预测评分模型。评分的验证表明诊断性能良好。
OBJECTIVE: Insufficient tools for bedside prediction of late-onset neonatal sepsis (LNS) initiated this study. The objective was to develop and validate a simple prediction-scoring model for LNS defined as culture-proven sepsis occurring 72 hours after birth.METHODS: The study was performed at a university hospital in Bangkok. The derivation phase included medical records of 1870 neonates, randomly selected from 9347 records of neonates who had been hospitalized for >72 hours during 1998 to 2000, of which 1824 records were available. In all, 100 neonates were clinically suspected of sepsis and 17 had proven LNS. The validation phase included 73 neonates suspected of having sepsis during July 2002 to June 2003 and 25 who had LNS. Weighted coefficients from Cox's proportional hazards model and receiver-operating-characteristic (ROC) curve analysis were used.RESULTS: The incidence density of LNS was 17/11355 (1.5/1000) person-days. A scoring model was developed and consisted of the following: hypotension (score 4), abnormal body temperature (score 3), respiratory insufficiency (score 2), neutrophil band form fraction >1% (score 2), platelet count 7 days; score 2 or 4). The area under the ROC curves for prediction of LNS in a neonate suspected of sepsis in each of the two phases was 0.85 and 0.80, respectively (p=0.436). The mean probabilities of LNS were approximately 0.10 (low risk) for scores from 0 to 3; 0.50 (intermediate risk) for scores from 4 to 6; and 0.70 (high risk) for scores > or =7.CONCLUSION: A simple prediction-scoring model for LNS was developed. Validation of the scores suggested good diagnostic performance.