Prospective validation of pediatric disease severity scores to predict mortality in Ugandan children presenting with malaria and non-malaria febrile illness
Prospective validation of pediatric disease severity scores to predict mortality in Ugandan children presenting with malaria and non-malaria febrile illness
复制标题
DOI：
10.1186/s13054-015-0773-4
复制
发表时间：
2015-02-23
期刊：
影响因子：
15.1
通讯作者：
Kain, Kevin C.
中科院分区：
文献类型：
--
作者：
Conroy, Andrea L.;Hawkes, Michael;Kain, Kevin C.
导言：开发简单的临床工具来识别有死亡风险的儿童，将有助于迅速和合理地实施挽救生命的措施，以降低全球儿童死亡率。方法：我们评估了三种临床评分系统预测乌干达发烧儿童住院死亡率的前瞻性观察研究的能力。我们计算了lamarene器官功能障碍评分（LODS）、致死性儿童炎症症状（SICK）和非洲儿童早期死亡指数（PEDIA）。通过比较受试者工作特征曲线（auc）下的面积来评估模型判别性，并使用Hosmer-Lemeshow拟合优度检验来评估校准。对疟疾与非疟疾发热性疾病（NMFI）以及早期（48小时）死亡进行了亚分析。结果：共有2089名已知结局的儿童被纳入研究（99例死亡，4.7%死亡率）。所有三种评分系统都产生了良好的区分(auc， 95%置信区间（CI）： LODS, 0.90, 0.88至0.91；SICK, 0.85, 0.83 ~ 0.86；PEDIA, 0.90, 0.88 ~ 0.91)。使用约登指数确定最佳临界值，LODS具有最高的阳性似然比（+LR, 95% CI: LODS, 6.5, 5.6至7.6；SICK, 4.4, 3.9至5.0；PEDIA, 4.4, 3.9至5.0），而PEDIA具有最低的负似然比(-LR, 95% CI: LODS, 0.21, 0.1至0.3；SICK, 0.22, 0.1至0.3；PEDIA, 0.16, 0.1至0.3)，LODS和PEDIA校正良好（P = 0.79和P = 0.21分别），并且在区分疟疾幸存者和非幸存者方面具有高于SICK的auc (auc, 95% CI: LODS, 0.92, 0.90至0.93；SICK, 0.86, 0.84至0.87；PEDIA, 0.92, 0.90至0.93)，但在NMFI中具有类似的auc （auc, 95% CI: LODS, 0.86, 0.83至0.89；SICK, 0.82, 0.79至0.86；PEDIA, 0.87, 0.83至0.893）。研究中大多数死亡发生在早期（n = 85.5%, 85.9%），其中LODS和PEDIA具有良好的区分性。结论：所有三种评分系统都能预测预后，但LODS作为临床预后评分最有希望，因为它计算简单，不需要设备，而且判别性好。
Introduction: The development of simple clinical tools to identify children at risk of death would enable rapid and rational implementation of lifesaving measures to reduce childhood mortality globally.Methods: We evaluated the ability of three clinical scoring systems to predict in-hospital mortality in a prospective observational study of Ugandan children with fever. We computed the Lambarene Organ Dysfunction Score (LODS), Signs of Inflammation in Children that Kill (SICK), and the Pediatric Early Death Index for Africa (PEDIA). Model discrimination was evaluated by comparing areas under receiver operating characteristic curves (AUCs) and calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test. Sub-analyses were performed in malaria versus non-malaria febrile illness (NMFI), and in early (48 hours) deaths.Results: In total, 2089 children with known outcomes were included in the study (99 deaths, 4.7% mortality). All three scoring systems yielded good discrimination (AUCs, 95% confidence interval (CI): LODS, 0.90, 0.88 to 0.91; SICK, 0.85, 0.83 to 0.86; PEDIA, 0.90, 0.88 to 0.91). Using the Youden index to identify the best cut-offs, LODS had the highest positive likelihood ratio (+LR, 95% CI: LODS, 6.5, 5.6 to 7.6; SICK, 4.4, 3.9 to 5.0; PEDIA, 4.4, 3.9 to 5.0), whereas PEDIA had the lowest negative likelihood ratio (-LR, 95% CI: LODS, 0.21, 0.1 to 0.3; SICK, 0.22, 0.1 to 0.3; PEDIA, 0.16, 0.1 to 0.3), LODS and PEDIA were well calibrated (P = 0.79 and P = 0.21 respectively), and had higher AUCs than SICK in discriminating between survivors and non-survivors in malaria (AUCs, 95% CI: LODS, 0.92, 0.90 to 0.93; SICK, 0.86, 0.84 to 0.87; PEDIA, 0.92, 0.90 to 0.93), but comparable AUCs in NMFI (AUCs, 95% CI: LODS, 0.86, 0.83 to 0.89; SICK, 0.82, 0.79 to 0.86; PEDIA, 0.87, 0.83 to 0.893). The majority of deaths in the study occurred early (n = 85, 85.9%) where LODS and PEDIA had good discrimination.Conclusions: All three scoring systems predicted outcome, but LODS holds the most promise as a clinical prognostic score based on its simplicity to compute, requirement for no equipment, and good discrimination.