Accuracy Comparison Between Age-Adapted SOFA and SIRS in Predicting in-Hospital Mortality of Infected Children at China's PICU
Accuracy Comparison Between Age-Adapted SOFA and SIRS in Predicting in-Hospital Mortality of Infected Children at China's PICU
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年龄适应SOFA与SIRS预测中国PICU感染儿童院内死亡率的准确性比较
DOI：
10.1097/shk.0000000000001261
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发表时间：
2019-09-01
期刊：
影响因子：
3.1
通讯作者：
Liang, Huiying
中科院分区：
文献类型：
--
作者：
Wu, Zhiyuan;Liang, Yafeng;Liang, Huiying
目的：脓毒症-3共识建议“需要为儿科人群制定类似的更新定义。序贯器官衰竭评估（SOFA）和全身炎症反应综合征（SIRS）标准是广泛用于定义感染状态的两个系统。然而，目前尚不清楚SOFA在预测低收入和中等收入国家儿童死亡率方面是否比SIRS更准确。因此，我们验证了年龄适应的SOFA和SIRS预测中国儿科重症监护病房（PICU）感染儿童预后不良的准确性。研究方法：我们对2009年1月1日至2017年12月31日期间因感染而入住PICU的儿童进行了回顾性和观察性队列研究。根据年龄适应性SOFA和SIRS对ICU入院后24 h内的指标进行分析，所有数据均来自医院电子健康档案数据库。用主要结局和次要结局说明预后。主要结局指住院死亡率，次要结局指住院死亡率或ICU住院时间>= 7天。使用原始和校正的受试者工作特征曲线下面积（AUROC）比较年龄适应性SOFA和SIRS的预测能力。结果：在1，831名因感染而入住PICU的儿童中，164名（9.0%）出现主要结局，948名（51.8%）出现次要结局。在164例死亡中，65.9%为男性（中位年龄为7.53个月，范围为2.67-41.00个月）。年龄适应性SOFA评分≥ 2分或符合两项SIRS标准的儿童分别占92.5%和73.3%。此外，年龄适应性SOFA评分≥ 2比儿科SIRS更准确地预测不良结局（校正的AUROC，0.753; 0.713-0.796 vs. 0.674; 0.631-0.702; P < 0.001）。结论：与SIRS标准相比，SOFA评分≥ 2分预测ICU患儿院内死亡率的准确性更高，对鉴别重症感染的敏感性更高。
Objectives: Sepsis-3 consensus suggests "the need to develop similar updated definitions for pediatric populations." Sequential organ failure assessment (SOFA) and systemic inflammatory response syndrome (SIRS) criteria are two systems widely used to define the status of infection. However, it is still unclear whether SOFA is more accurate than SIRS in predicting children mortality in low- and middle-income countries. Thus, we validated the accuracy of age-adapted SOFA and SIRS in predicating the poor prognosis of infected children in China's pediatric intensive care unit (PICU). Methods: We performed a retrospective and observational cohort study of children admitted for infection to PICU in the hospital between January 1, 2009 and December 31, 2017. The indexes within 24 h after intensive care unit (ICU) admission were analyzed according to age-adapted SOFA and SIRS, and all data were sourced from the hospital's electronic health record database. The prognosis was illustrated with primary outcome and secondary outcome. Primary outcome referred to in-hospital mortality, and secondary outcome to in-hospital mortality or ICU length of stay >= 7 days. The predictive power of age-adapted SOFA and SIRS was compared using crude and adjusted area under the receiver operating characteristic curve (AUROC). Results: Of 1,831 PICU-admitted children due to infection, 164 (9.0%) experienced primary outcome, and 948 (51.8%) secondary outcome. Of 164 deaths, 65.9% were males (median age of 7.53 months, range of 2.67-41.00 months). Children who scored >= 2 in age-adapted SOFA or met two SIRS criteria accounted for 92.5% and 73.3%, respectively. In addition, age-adapted SOFA score of >= 2 predicted adverse outcome more accurately than pediatric SIRS (adjusted AUROC, 0.753; 0.713-0.796 vs. 0.674; 0.631-0.702; P < 0.001). Conclusion: Compared with SIRS criteria, age-adapted SOFA score of >= 2 enjoys a more accuracy in predicting in-hospital mortality of PICU-admitted children, and a higher sensitivity in identifying children with severe infection.