Performance of Three Mortality Prediction Scores and Evaluation of Important Determinants in Eight Pediatric Intensive Care Units in China

Frontiers in Pediatrics

article

Zhengzheng Zhang¹  Weiming Chen¹  Juanzhen Li²  Dongni Su³  Yanlong Bi⁴  Zhenjie Chen⁵  Bingxin Jin⁶  Huijie Miao⁷  Xiangmei Kong⁸  Ye Cheng¹  Yang Chen¹  Xiangyuan Huang⁹  Gangfeng Yan¹  Weili Yan⁹  Guoping Lu¹  Ying Wang²  Ying Li³  Hongjun Miao⁴  Chenmei Zhang⁵  Guoquan Pan⁶  Yucai Zhang⁷  Xiaodong Zhu⁸ 

[1] Pediatric Emergency and Critical Care Center, Children's Hospital of Fudan University;Pediatric Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine;Intensive Care Unit, Children's Hospital of Soochow University;Department of Emergency, Children's Hospital of Nanjing Medical University;Pediatric Intensive Care Unit, Children's Hospital of Zhejiang University School of Medicine;Pediatric Intensive Care Unit, The Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University;Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University;Department of Pediatric Critical Care Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine;Department of Clinical Epidemiology, Children's Hospital of Fudan University

关键词: pediatric intensive care unit;    mortality;    cohort study;    prediction model;    model validation;   

DOI  :  10.3389/fped.2020.00522

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: The mortality prediction scores were widely used in pediatric intensive care units. However, their performances were unclear in Chinese patients and there were also no reports based on large sample sizes in China. This study aims to evaluate the performances of three existing severity assessment scores in predicting PICU mortality and to identify important determinants. Methods: This prospective observational cohort study was carried out in eight multidisciplinary, tertiary-care PICUs of teaching hospitals in China. All eligible patients admitted to the PICUs between Aug 1, 2016, and Jul 31, 2017, were consecutively enrolled, among whom 3,957 were included for analysis. We calculated PCIS, PRISM IV, and PELOD-2 scores based on patient data collected in the first 24 h after PICU admission. The in-hospital mortality was defined as all-cause death within 3 months after admission. The discrimination of mortality was assessed using the area under the receiver-operating characteristics curve (AUC) and calibrated using the Hosmer–Lemeshow goodness-of-fit test. Results: A total of 4,770 eligible patients were recruited (median age 18.2 months, overall mortality rate 4.7%, median length of PICU stay 6 days), and 3,957 participants were included in the analysis. The AUC (95% confidence intervals, CI) were 0.74 (0.71–0.78), 0.76 (0.73–0.80), and 0.80 (0.77–0.83) for PCIS, PRISM IV, and PELOD-2, respectively. The Hosmer–Lemeshow test gave a chi-square of 3.16 for PCIS, 2.16 for PRISM IV and 4.81 for PELOD-2 ( p ≥ 0.19). Cox regression identified five predictors from the items of scores better associated with higher death risk, with a C-index of 0.83 (95%CI 0.79–0.86), including higher platelet (HR = 1.85, 95% CI 1.59–2.16), invasive ventilation (HR = 1.40, 1.26–1.55), pupillary light reflex (HR = 1.31, 95% CI 1.22–1.42) scores, lower pH (HR 0.89, 0.84–0.94), and extreme PaO 2 (HR 2.60, 95% CI 1.61–4.19 for the 1st quantile vs. 4th quantile) scores. Conclusions: Performances of the three scores in predicting PICU mortality are comparable, and five predictors were identified with better prediction to PICU mortality in Chinese patients.

【 授权许可】

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