检索历史 清除

目的:分析儿童重症医学科(PICU)重症肺炎患儿死亡的危险因素，探讨改良PIRO(mPIRO)评分量表对死亡风险的预测价值，并适当改进。方法:病例对照研究。回顾性分析2015年5月至2021年12月重庆医科大学附属儿童医院PICU诊治的460例重症肺炎患儿的临床资料，以是否发生死亡将研究对象分为存活组(411例)和死亡组(49例)。采用Logistic回归分析PICU重症肺炎患儿死亡的危险因素，应用mPIRO评分量表评估其死亡风险，将量表中脉搏氧饱和度(SpO 2)<0.90改进为SpO 2与吸入气氧体积分数比值≤160形成改进后的评分量表，通过绘制受试者工作特征(ROC)曲线、校准曲线及决策曲线分析(DCA)比较2个评分量表的预测性能。 结果:Logistic回归分析发现，发生低血压、急性肝衰竭、急性肾损伤、急性呼吸窘迫综合征及血糖升高是PICU重症肺炎患儿死亡的独立危险因素(均 P<0.05)。ROC曲线分析显示，改进后的评分量表的曲线下面积为0.747，显著高于mPIRO评分量表的0.718( P<0.05)；校准曲线显示，改进后的评分量表的预测结果与实际结果间的一致性更好，DCA显示当阈值概率为0.1～0.4时，改进后的评分量表的净获益高于mPIRO评分量表。 结论:发生低血压、急性肝衰竭、急性肾损伤、急性呼吸窘迫综合征及血糖升高是PICU重症肺炎患儿死亡的独立危险因素，mPIRO评分量表及改进后的评分量表对PICU重症肺炎患儿死亡具有一定的预测价值，且改进后的评分量表更佳。

Objective:To analyze the risk factors associated with death in children with severe pneumonia admitted to the pediatric intensive care unit (PICU), investigate the predictive value of the modified PIRO (mPIRO) scale in assessing the risk of death in these children, and improve the scale appropriately.Methods:In this case-control study, a retrospective analysis was conducted on the clinical data of 460 children with severe pneumonia in the PICU at Children′s Hospital of Chongqing Medical University from May 2015 to December 2021.Based on the occurrence of death, these children were divided into a survival group ( n=411) and a death group ( n=49).Logistic regression analysis was performed to identify the risk factors associated with death in children with severe pneumonia in the PICU.The mPIRO scale was employed to evaluate the mortality risk, wherein the pulse oxygen saturation (SpO 2)<0.90 of the scale was revised to the ratio of SpO 2/fraction of inspired oxygen≤160 to form the modified scale.The predictive effect of both scales was compared using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Results:The Logistic regression analysis revealed hypotension, acute hepatic failure, acute kidney injury, acute respiratory distress syndrome, and elevated blood glucose were independent risk factors for death in children with severe pneumonia in the PICU (all P<0.05).The ROC curve demonstrated that the area under the curve (AUC) of the modified scale was 0.747, significantly higher than that of the mPIRO scale (AUC=0.718, P<0.05).The calibration curve illustrated that the modified scale had a better fit between the predicted result and the actual result.The DCA revealed that the modified scale had a higher net benefit compared to the mPIRO scale at probability thresholds of 0.1 to 0.4. Conclusions:Hypotension, acute hepatic failure, acute kidney injury, acute respiratory distress syndrome, and elevated blood glucose are identified as independent risk factors for death in children with severe pneumonia in the PICU.Both the mPIRO scale and the modified scale show predictive value in assessing mortality risk for children with severe pneumonia in the PICU, with the modified scale demonstrating superior performance.