5种评分方法在儿童急性呼吸窘迫综合征预后评估中的应用价值

doi:10.12372/jcp.2023.22e1197

Abstract

Abstract:

Objective To explore the application value of pediatric critical illness score (PCIS), pediatric risk of mortality (PRISM) Ⅲ score, pediatric sequential organ failure assessment (pSOFA) score, radiographic assessment of lung edema (RALE) score and acute lung injury score (LIS) in the prognosis evaluation of pediatric acute respiratory distress syndrome (pARDS). Methods The clinical data of children diagnosed with ARDS admitted to the pediatric intensive care unit (PICU) from January 2015 to December 2021 were retrospectively analyzed. Results A total of 80 ARDS children with sepsis and multiple organ dysfunction were enrolled, including 45 boys and 35 girls, and the median age was 12.5 (4.0-36.3) months. There were 50 patients in the survival group and 30 patients in the death group (16 died during hospitalization and 14 died after abandonment). Compared with the survival group, the death group had higher oxygenation index (OI), higher pSOFA and PRISM Ⅲ scores at transferring to PICU and diagnosing ARDS, higher RALE and LIS scores at diagnosing ARDS, and higher proportion of vasoactive substances application and blood transfusion. Furthermore, compared with the survival group, the death group had shorter total hospital stay, PICU stay and mechanical ventilation time, and lower proportion of intrapulmonary factors, PO₂/FiO₂ and PCIS scores. The differences were statistically significant (P<0.05). Compared with the group without underlying diseases, the scores of pSOFA, PRISM Ⅲ, RALE, and LIS were higher and the scores of PCIS were lower at the diagnosis of ARDS in the group with underlying diseases, the differences were statistically significant (P<0.05). The AUCs of PCIS, pSOFA, PRISM Ⅲ, RALE, and LIS at the diagnosis of ARDS in predicting the death of ARDS children were 0.73, 0.89, 0.83, 0.80 and 0.82, respectively. Hosmer-Lemeshow goodness of fit test showed that PCIS had the best fitting effect between predicted mortality and actual mortality (χ²=4.16, P=0.656). Conclusions PCIS, pSOFA, PRISM Ⅲ, RALE and LIS scores all have good predictive ability for the prognosis of children with ARDS, and pSOFA score had the highest predictive value. PCIS had the best fitting effect between predicted mortality and actual mortality.

Key words: acute respiratory distress syndrome, clinical score, prognosis evaluation, child

QIAO Junying, ZHANG Luodan, LI Fan, ZHAO Jianchuang, GUO Shanshan, ZHANG Jingpo. The application value of 5 scoring methods in the prognosis evaluation of acute respiratory distress syndrome in children[J].Journal of Clinical Pediatrics, 2023, 41(6): 442-449.

Figures/Tables 4

References 34

[1]	Beltramo F, Khemani RG. Definition and global epidemiology of pediatric acute respiratory distress syndrome[J]. Ann Transl Med, 2019, 7(19): 502-509. doi: 10.21037/atm.2019.09.31 pmid: 31728355
[2]	Chen W, Ware LB. Prognostic factors in the acute respiratory distress syndrome[J]. Clin Transl Med, 2015, 4(1): 1-9.
[3]	曾健生, 钱素云. 儿童急性呼吸窘迫综合征诊断标准适用性和影响[J]. 中华儿科杂志, 2020, 58(11): 949-952.
[4]	李茂新, 李秋玲, 刘嘉欣, 等. 急性呼吸窘迫综合征的诊疗研究进展[J]. 疑难病杂志, 2021, 20(3): 304-309.
[5]	中华医学会儿科学分会急救学组. 第四届全国小儿急救医学研讨会纪要[J]. 中华儿科杂志, 1995, 36(6): 370-373.
[6]	Matics TJ, Sanchez-Pinto LN. Adaptation and validation of a pediatric sequential organ failure assessment score and evaluation of the sepsis-3 definitions in critically ill children[J]. JAMA Pediatr, 2017, 171(10): e172352.
[7]	Pollack MM, Holubkov R, Funai T, et al. The pediatric risk of mortality score: update 2015[J]. Pediatr Crit Care Med, 2016, 17(1): 2-9. doi: 10.1097/PCC.0000000000000558
[8]	Tian L, Cao Z, Lin J, et al. Value of radiographic assessment of lung edema score in evaluating the severity and prognosis of patients with acute respiratory distress syndrome[J]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 2021, 33(5): 557-562.
[9]	Hammer J, Numa A, Newth C. Acute respiratory distress syndrome caused by respiratory syncytial virus[J]. Pediatr Pulmonol, 1997, 23(3): 176-183. doi: 10.1002/(ISSN)1099-0496
[10]	钱素云, 杨梅, 曾健生. 儿童急性呼吸窘迫综合征诊治进展及思考[J]. 中华急诊医学杂志, 2020, 29(6): 747-750.
[11]	Wong JJ, Jit M, Sultana R, et al. Mortality in pediatric acute respiratory distress syndrome: a systematic review and meta-analysis[J]. J Intensive Care Med, 2019, 34(7): 563-571. doi: 10.1177/0885066617705109
[12]	陈容欣, 曹佳颖, 崔云. 体外膜肺氧合在儿童急性呼吸窘迫综合征中的应用[J]. 中国实用儿科杂志, 2022, 37(3): 181-185.
[13]	杨妮, 刘春峰. 欧洲急性呼吸窘迫综合征的呼吸支持专家意见解读[J]. 中国小儿急救医学, 2019, 26 (6): 423-426.
[14]	陈扬, 陆国平. 影响急性呼吸窘迫综合征预后的危险因素[J]. 中国小儿急救医学, 2019, 26(6): 406-411.
[15]	Khemani RG, Smith L, Lopez-Fernandez YM, et al. Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study[J]. Lancet Respir Med, 2019, 7(2): 115-128. doi: 10.1016/S2213-2600(18)30344-8 pmid: 30361119
[16]	Wong JJM, Tan HL, Lee SW, et al. Characteristics and trajectory of patients with pediatric acute respiratory distress syndrome[J]. Pediatr Pulmonol, 2020, 55(4): 1000-1006. doi: 10.1002/ppul.v55.4
[17]	王明强, 赵子瑜. 脓毒症并发急性呼吸窘迫综合征患者预后的影响因素分析[J]. 中国实用医刊, 2022, 49(15): 36-39.
[18]	姜叶洁, 冯庆红, 魁艳凤, 等. 急诊儿科改良早期预警评分对病情评估的作用[J]. 中国医药科学, 2022, 12(05): 103-105.
[19]	Lalitha AV, Satish JK, Reddy M, et al. Sequential organ failure assessment score as a predictor of outcome in sepsis in pediatric intensive care unit[J]. J Pediatr Intensive Care, 2021, 10(02): 110-117. doi: 10.1055/s-0040-1714705
[20]	El-Mashad GM, El-Mekkawy MS, Zayan MH. Paediatric sequential organ failure assessment (pSOFA) score: a new mortality prediction score in the paediatric intensive care unit[J]. An Pediatr (Engl Ed), 2020, 92(5): 277-285.
[21]	罗永田, 孙慧, 蒋支贵. 小儿危重病例评分法对儿童重症监护病房患儿的评估效果[J]. 中国医药, 2022, 17(1): 80-83.
[22]	应佳云, 张铮铮, 陆国平. 儿童危重病例评分和第三代儿童死亡危险评分在危重患儿的应用情况[J]. 中国循证儿科杂志, 2018, 13(3): 185-189.
[23]	张丽丹, 黄慧敏, 程玉才, 等. 4种小儿危重死亡评分对危重患儿死亡风险的预测价值[J]. 中华危重病急救医学, 2018, 30(1): 51-56.
[24]	Kaur A, Kaur G, Dhir SK, et al. Pediatric risk of mortality III score-Predictor of mortality and hospital stay in pediatric intensive care unit[J]. J Emerg Trauma Shock, 2020, 13(2): 146-150. doi: 10.4103/JETS.JETS_89_19
[25]	Khajeh A, Noori NM, Reisi M, et al. Mortality risk prediction by application of pediatric risk of mortality scoring system in pediatric intensive care unit[J]. Iran J Pediatr, 2013, 23(5): 546-550. pmid: 24800015
[26]	卢秀兰, 仇君, 祝益民, 等. 儿童死亡风险评分和小儿死亡指数评分在危重患儿病情评价中的效能[J]. 中华儿科杂志, 2015, 53(005): 370-374.
[27]	潘频华, 宋超, 戴敏惠, 等. 急性呼吸窘迫综合征患者肺病理生理的异质性[J]. 中华医学杂志, 2018, 98(34): 2709-2711.
[28]	Bos LD, Ware LB. Acute respiratory distress syndrome: causes, pathophysiology, and phenotypes[J]. Lancet, 2022, 400(10358): 1145-1156. doi: 10.1016/S0140-6736(22)01485-4 pmid: 36070787
[29]	唐敏, 李娜. 急性呼吸窘迫综合征发病机制及相关生物标志物的研究进展[J]. 中国现代医学杂志, 2022, 32(5): 1-6.
[30]	Zimatore C, Pisani L, Lippolis V, et al. The radiographic assessment of lung edema (RALE) score has excellent diagnostic accuracy for ARDS[J]. Eur Respir J, 2019, 54: OA3299.
[31]	Zimatore C, Pisani L, Lippolis V, et al. Accuracy of the radiographic assessment of lung edema score for the diagnosis of ARDS[J]. Front Physiol, 2021, 12: 672823.
[32]	Jabaudon M, Audard J, Pereira B, et al. Early changes over time in the radiographic assessment of lung edema score are associated with survival in ARDS[J]. Chest, 2020, 158(6): 2394-2403. doi: 10.1016/j.chest.2020.06.070 pmid: 32659235
[33]	Murray JF, Matthay MA, Luce JM, et al. An expanded definition of the adult respiratory distress syndrome[J]. Am Rev Respir Dis, 1988, 138(3): 720-723. doi: 10.1164/ajrccm/138.3.720
[34]	Kangelaris KN, Calfee CS, May AK, et al. Is there still a role for the lung injury score in the era of the Berlin definition ARDS?[J]. Ann Intensive Care, 2014, 4(1): 4-13. doi: 10.1186/2110-5820-4-4 pmid: 24533450

项目	存活组(n=50)	死亡组(n=30)	统计量	P
年龄[M(P₂₅~P₇₅)]/月	14.0(4.0~37.5)	11.5(4.0~30.0)	Z=0.14	0.885
男性[n(%)]	28(56.0)	17(56.7)	χ²=0.00	0.954
体重[M(P₂₅~P₇₅)]/kg	9.4(5.0~15.0)	8.0(5.2~12.3)	Z=0.27	0.785
收缩压(x±s)/mmHg	97.0±13.8	91.0±15.6	t=1.68	0.096
总住院时间[M(P₂₅~P₇₅)]/d	23.0(16.0~39.0)	13.0(7.3~16.8)	Z=3.92	<0.001
PICU住院时间[M(P₂₅~P₇₅)]/d	21.0(15.0~27.8)	5.0(2.0~12.0)	Z=5.53	<0.001
机械通气时间[M(P₂₅~P₇₅)]/d	9.0(7.0~13.3)	5.5(3.0~11.5)	Z=3.23	0.001
有创机械通气[n(%)]	47(94.0)	30(100)	χ²=0.58	0.447
肺内/肺外因素	44/6	17/13	χ²=10.17	0.001
合并基础疾病[n(%)]	15(30.0)	21(70.0)	χ²=12.12	<0.001
使用血管活性药物[n(%)]	14(28.0)	25(83.3)	χ²=22.98	<0.001
输血[n(%)]	22(44.0)	23(76.7)	χ²=8.13	0.004
丙种球蛋白治疗[n(%)]	43(86.0)	29(96.7)	χ²=1.33	0.248
病情程度(轻/中/重)	29/15/6	0/15/15	χ²=29.71	<0.001
PO₂/FiO₂[M(P₂₅~P₇₅)]/mmHg	187.5(123.8~216.0)	95.5(76.5~120.0)	Z=4.98	<0.001
氧合指数OI[M(P₂₅~P₇₅)]	6.0(5.0~11.2)	15.7(12.2~24.7)	Z=5.06	<0.001
白细胞计数[M(P₂₅~P₇₅)]/×10⁹·L^-1	8.5(4.7~13.8)	14.2(6.3~24.3)	Z=1.73	0.084
转入PICU时[M(P₂₅~P₇₅)]/分
PCIS评分	84.0(80.0~86.5)	82.0(74.5~88.0)	Z=1.32	0.188
pSOFA评分	3.0(3.0~5.3)	7.0(4.0~9.0)	Z=3.93	<0.001
PRISM Ⅲ评分	3.0(2.0~5.0)	7.5(2.0~13.0)	Z=2.82	0.005
ARDS发生时[M(P₂₅~P₇₅)]/分
RALE评分	20.0(16.0~24.0)	27.0(24.0~28.3)	Z=4.51	<0.001
LIS评分	2.5(2.3~2.8)	3.0(2.8~3.3)	Z=4.87	<0.001
PCIS评分	84.0(80.0~86.0)	76.0(70.0~84.0)	Z=3.38	0.001
pSOFA评分	3.0(3.0~6.0)	9.0(7.8~11.3)	Z=5.82	<0.001
PRISM Ⅲ评分	3.0(2.0~6.0)	10.0(7.0~14.5)	Z=4.87	<0.001

项目	不合并基础疾病组(n=44)	合并基础疾病组(n=36)	Z值	P
PCIS评分	84.0(80.0~86.0)	79.0(70.5~82.0)	3.44	0.001
pSOFA评分	3.0(3.0~6.0)	9.0(5.3~10.8)	5.01	<0.001
PRISMⅢ评分	3.0(2.0~6.0)	9.5(5.3~14.0)	5.29	<0.001
RALE评分	20.0(16.0~24.0)	27.0(20.0~27.8)	3.39	0.001
LIS评分	2.5(2.3~2.8)	2.9(2.8~3.0)	4.17	<0.001

评分	最佳截断值	AUC(95%CI)	P	灵敏度/%	特异度/%
PCIS	77.0	0.73(0.61~0.85)	0.001	53.3	86.0
pSOFA	7.5	0.89(0.82~0.96)	<0.001	76.7	82.0
PRISMⅢ	5.5	0.83(0.72~0.94)	<0.001	83.3	72.0
RALE	23.0	0.80(0.70~0.90)	<0.001	80.0	70.0
LIS	2.6	0.82(0.73~0.91)	<0.001	93.3	62.0

例数	存活		死亡		例数	存活		死亡
例数	观察值	预测值	观察值	预测值	例数	观察值	预测值	观察值	预测值
PCIS					pSOFA
13	11	10.9	2	2.1	8	8	7.6	0	0.4
7	4	5.6	3	1.4	18	18	16.5	0	1.5
14	11	10.6	3	3.4	6	5	5.2	1	0.8
7	6	5.0	1	2.1	8	5	6.5	3	1.5
11	8	7.1	3	3.9	8	5	5.5	3	2.5
9	4	5.0	5	4.0	4	2	1.9	2	2.1
8	4	3.5	4	4.5	13	5	4.7	8	8.3
11	2	2.3	9	8.7	9	1	1.8	8	7.2
					6	1	0.2	5	5.8
PRISM Ⅲ					RALE
9	6	8.2	3	0.8	9	8	8.5	1	0.5
10	10	8.7	0	1.3	6	6	5.4	0	0.6
11	11	9.1	0	1.9	9	8	7.7	1	1.3
11	9	8.3	2	2.7	13	9	10.2	4	2.8
8	7	5.4	1	2.6	4	4	2.8	0	1.2
10	3	5.6	7	4.4	10	5	5.7	5	4.3
8	2	3.2	6	4.8	1	0	0.5	1	0.5
8	2	1.3	6	6.7	16	8	6.3	8	9.7
5	0	0.2	5	4.8	12	2	2.9	10	9.1
LIS
4	4	3. 9	0	0.1
14	14	12.9	0	1.1
15	13	12.2	2	2.8
22	11	13.8	11	8.2
13	4	5.1	9	7.9
12	4	2.1	8	9.9

The application value of 5 scoring methods in the prognosis evaluation of acute respiratory distress syndrome in children

RichHTML

PDF (PC)

Like

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 4

References 34

Related Articles 15

Metrics

Comments

Recommended 0

[1]	LIN Jinfeng, CHEN Yi, DENG Yan, FENG Ai, HUANG Juan, CHEN Lizhu, XIE Jingqi, NIE Xiaojing. A comparative study on the detection of anti-Nephrin antibodies in children's nephrotic syndrome by chemiluminescence method and cell-based assay [J]. Journal of Clinical Pediatrics, 2026, 44(8): 682-689.
[2]	ZHENG Fangyuan, WANG Miao, DING Mingming, LU Aidong, JIA Yueping, ZENG Huimin, ZHANG Leping. Next-generation sequencing identified gene variants and their prognostic impact in pediatric Philadelphia chromosome positive acute lymphoblastic leukemia [J]. Journal of Clinical Pediatrics, 2026, 44(8): 690-697.
[3]	ZHANG Xiao, FANG Hongjun, KUANG Xiaojun, WANG Lijuan, WU Zhao, JIANG Sha, LI Pei, WU Liwen. Analysis of the clinical and electrophysiological characteristics of atonic seizures in children [J]. Journal of Clinical Pediatrics, 2026, 44(8): 698-704.
[4]	WANG Mengqian, YANG Hui. Case series analysis of 13 intestinal Behcet’s syndrome in children [J]. Journal of Clinical Pediatrics, 2026, 44(8): 705-711.
[5]	WU Xirong, GAO Qi, GUO Siyuan, YIN Qingqin, QIN Qiang, YIN Ju, JIAO Anxia, CHEN Chenghao, WU Di, WANG Bei, DUAN Xiaomin, PENG Yun, XU Baoping, GAO Liwei. Clinical characteristics and prognosis of pulmonary mucormycosis in children with diabetes mellitus [J]. Journal of Clinical Pediatrics, 2026, 44(8): 712-720.
[6]	HAN Yanan, GE Lanlan, CUI Jieyuan. A case report of branchio-oto-renal syndrome caused by EYA1 gene variant with a 6-year follow-up [J]. Journal of Clinical Pediatrics, 2026, 44(8): 721-726.
[7]	SHI Jiayi, GAO Chunlin, JIA Lili, LU Yunyun, SUN Tao, ZHU Xiaodong, XIA Zhengkun, ZHANG Pei. Phenotypic characteristics and prognostic analysis of a pedigree with childhood isolated nephrotic syndrome caused by compound heterozygous mutations in the COQ2 gene [J]. Journal of Clinical Pediatrics, 2026, 44(8): 727-732.
[8]	Rachel Rosen, Osvaldo Borrelli, Christophe Faure, Katja Karrento, Usha Krishnan, Samuel Nurko, Nathalie Rommel, Alan Silverman, Michiel van Wijk, Marc Benninga (Author), Chinese Medical Association Parenteral and Enteral Nutrition Branch Pediatrics Group, The Subspecialty Group of Gastroenterology, The Society of Pediatric, Chinese Medical Association, Gastroenterology Group, Pediatrician Branch, Chinese Medical Doctor Association (Translator). Core interpretation and explanation of Rome Ⅴ diagnostic criteria: upper gastrointestinal disorders of gut-brain interaction in children and adolescents [J]. Journal of Clinical Pediatrics, 2026, 44(7): 595-608.
[9]	Carlo Di Lorenzo, Miguel Saps, Bruno P. Chumpitazi, Shaman Rajindrajith, Annamaria Staiano, Nikhil Thapar, Miranda van Tilburg, Carlos Velasco-Benítez, Arine Vlieger (Author), Chinese Medical Association Parenteral and Enteral Nutrition Branch Pediatrics Group, The Subspecialty Group of Gastroenterology, The Society of Pediatric, Chinese Medical Association, Gastroenterology Group, Pediatrician Branch, Chinese Medical Doctor Association (Translator). Core interpretation and explanation of Rome Ⅴ diagnostic criteria: lower and biliary disorders of gut-brain interaction in children and adolescents [J]. Journal of Clinical Pediatrics, 2026, 44(7): 609-621.
[10]	LI Xufeng, TANG Haoxun, LI Xingjun, ZHANG Lize, GAO Chenqing, ZHAO Shunying, LIU Jianhua. Clinical characteristics, chest CT imaging phenotypes, and their correlation with prognosis in 76 children with Chlamydia pneumoniae pneumonia [J]. Journal of Clinical Pediatrics, 2026, 44(7): 622-627.
[11]	WANG Zhen, SHAO Jingbo, ZHANG Na, XIA Min, ZHU Jiashi, DU Chengkan, LI Hong. Factors influencing long-term recurrence in pediatric acute lymphoblastic leukemia patients with low-risk disease at initial diagnosis: a five-year follow-up analysis of 254 cases from a single center [J]. Journal of Clinical Pediatrics, 2026, 44(7): 628-635.
[12]	GUO Xuemei, XUE Yao, WANG Yongren, RONG Liucheng, FANG Yongjun, LIN Rufeng. Clinical features and prognosis of childhood acute myeloid leukemia with CBFA2T3::GLIS2 fusion [J]. Journal of Clinical Pediatrics, 2026, 44(7): 636-643.
[13]	YANG Lijun, FU Dongxia, CUI Yan, YANG Junmei, ZHANG Liming. Clinical manifestation and genetic analysis of CHARGE syndrome caused by CHD7 gene variation [J]. Journal of Clinical Pediatrics, 2026, 44(7): 644-650.
[14]	HU Yan, YANG Fan, LIANG Aimin, MAO Meng. Identification and management of faltering growth in children: insights from the 13th International Conference on Nutrition and Growth [J]. Journal of Clinical Pediatrics, 2026, 44(6): 485-488.
[15]	LIU Ziyao, WANG Congying, WANG Hongmao, ZHANG Mingming, XU Yingjie, LAI Jianming, NIU Wenquan, LI Xiaohui. Early differentiation of Kawasaki disease with joint symptoms and systemic juvenile idiopathic arthritis with Kawasaki disease-like symptoms: a single-center retrospective study [J]. Journal of Clinical Pediatrics, 2026, 44(6): 489-498.