Daily estimation of the severity of organ dysfunctions in critically ill children by using the PELOD-2 score.
Daily estimation of the severity of organ dysfunctions in critically ill children by using the PELOD-2 score.
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DOI：
10.1186/s13054-015-1054-y
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发表时间：
2015-09-15
期刊：
影响因子：
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通讯作者：
Groupe Francophone de Réanimation et Urgences Pédiatriques
中科院分区：
文献类型：
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作者：
Leteurtre S;Duhamel A;Deken V;Lacroix J;Leclerc F;Groupe Francophone de Réanimation et Urgences Pédiatriques
每日或连续评估多器官功能障碍综合征（MODS）评分可能提供有用的信息。我们的目的是使用先前版本评分中提出的7天组来验证每日（d）PELOD-2评分。在9个儿科重症监护室（PICU）收治的所有连续患者中，我们前瞻性地测量了第1、2、5、8、12、16和18天的dPELOD-2评分。以PICU死亡率为因变量。使用ROC曲线下面积和使用Hosmer-Lemeshow卡方检验的校准估计dPELOD-2评分的判别力。我们使用逻辑回归来研究dPELOD-2评分与结果之间的关系，以及第1天PELOD-2评分的变化与结果之间的关系。我们纳入了3669例患者（中位年龄15.5个月，死亡率6.1%，PICU平均住院时间3天）。未存活者的中位dPELOD-2评分显著高于存活者（p < 0.0001）。在2057例患者中，dPELOD-2评分至少在第2天可用：在第1天没有MODS的796例患者中，186例（23.3%）在PICU住院期间获得综合征（死亡率4.9% vs. 610例未获得综合征的患者中的0.3%; p < 0.0001）。在1261例第1天发生MODS的患者中，157例（12.4%）患者的综合征恶化，1104例（87.6%）患者的综合征保持不变或改善（死亡率22.9% vs.6.6%; p < 0.0001）。dPELOD-2评分的AUC范围为0.75（95% CI：0.67-0.83）至0.89（95% CI：0.86-0.91）。校准良好，卡方检验在13.5（p = 0.06）和0.9（p = 0.99）之间。第1天的PELOD-2评分是一个显著的预后因素;对第1天的dPELOD-2评分变化进行的系列评价（根据基线值进行调整）表明，7天中的每一天的死亡比值比均具有显著性。这项研究表明，器官功能障碍的严重程度的进展，可以通过测量的dPELOD-2评分在一组7天的PICU，提供有用的信息，在危重病患儿的结果进行评估。它的外部验证将是有益的。
Daily or serial evaluation of multiple organ dysfunction syndrome (MODS) scores may provide useful information. We aimed to validate the daily (d) PELOD-2 score using the set of seven days proposed with the previous version of the score. In all consecutive patients admitted to nine pediatric intensive care units (PICUs) we prospectively measured the dPELOD-2 score at day 1, 2, 5, 8, 12, 16, and 18. PICU mortality was used as the outcome dependent variable. The discriminant power of the dPELOD-2 scores was estimated using the area under the ROC curve and the calibration using the Hosmer-Lemeshow chi-square test. We used a logistic regression to investigate the relationship between the dPELOD-2 scores and outcome, and between the change in PELOD-2 score from day1 and outcome. We included 3669 patients (median age 15.5 months, mortality rate 6.1 %, median length of PICU stay 3 days). Median dPELOD-2 scores were significantly higher in nonsurvivors than in survivors (p < 0.0001). The dPELOD-2 score was available at least at day 2 in 2057 patients: among the 796 patients without MODS on day1, 186 (23.3 %) acquired the syndrome during their PICU stay (mortality 4.9 % vs. 0.3 % among the 610 who did not; p < 0.0001). Among the1261 patients with MODS on day1, the syndrome worsened in 157 (12.4 %) and remained unchanged or improved in 1104 (87.6 %) (mortality 22.9 % vs. 6.6 %; p < 0.0001). The AUC of the dPELOD-2 scores ranged from 0.75 (95 % CI: 0.67-0.83) to 0.89 (95 % CI: 0.86-0.91). The calibration was good with a chi-square test between 13.5 (p = 0.06) and 0.9 (p = 0.99). The PELOD-2 score on day1 was a significant prognostic factor; the serial evaluation of the change in the dPELOD-2 score from day1, adjusted for baseline value, demonstrated a significant odds ratio of death for each of the 7 days. This study suggests that the progression of the severity of organ dysfunctions can be evaluated by measuring the dPELOD-2 score during a set of 7 days in PICU, providing useful information on outcome in critically ill children. Its external validation would be useful.