pSOFA评分联合AGI分级评估脓毒症患儿预后的价值
Prognostic Value of pSOFA Score Combined with AGI Grade in Children with Sepsis
目的：分析脓毒症合并急性胃肠损伤（Acute Gastrointestinal Injury，AGI）患儿预后的影响因素，并讨论儿科序贯器官衰竭评估（Pediatric Sequential Organ Failure Assessment, pSOFA）评分、AGI分级及二者联合对其预后的预测价值。方法：选取 2020 年 1 月～2022 年 1月收治的143例脓毒症合并急性胃肠损伤患儿，依据病情程度分为脓毒症组和脓毒性休克组。收集临床资料、预后情况、确诊脓毒症当天pSOFA 评分、住院期间每日AGI评估并赋值，选取最高值与pSOFA评分相加得到联合评分。选用单因素和多因素 Logistic 回归分析患儿预后的影响因素，受试者工作特征曲线（receiver operating characteristic curve, ROC）分析 pSOFA 评分、 AGI分级及联合评分对预后不良的预测价值。结果：143例患儿中，脓毒症组103例（72.1%），脓毒性休克组40例（27.9%）。脓毒性休克组连续肾脏替代治疗、手术、机械通气、便血、肠鸣音减弱或消失的人数以及降钙素原均高于脓毒症组（P＜0.05）。脓毒性休克组红细胞、血红蛋白、血小板均低于脓毒症组（P＜0.05）。多因素 Logistic 回归分析显示，机械通气、手术、血红蛋白浓度降低、pSOFA评分升高、AGI分级升高为患儿预后不良的独立危险因素（P＜0.05）。ROC 曲线分析显示，pSOFA评分联合AGI分级对患儿预后的预测价值高于二者单独的预测价值（P＜0.05）。结论：机械通气、手术、血红蛋白、pSOFA评分、AGI分级为脓毒症合并急性胃肠损伤患儿预后的影响因素，pSOFA评分联合AGI分级预测其预后不良有较高价值。
Objective: To investigate the prognostic factors of acute gastrointestinal injury (AGI) in children with sepsis, and to explore the predictive value of Pediatric Sequential Organ Failure Assessment (pSOFA), AGI grade and their combined scores for prognosis.Methods:A total of 143 children with sepsis complicated with AGI from January 2020 to January 2022 were selected and divided into severe sepsis group and septic shock group according to the severity of disease. The clinical data and their outcomes were collected, and the pSOFA score was obtained on the day when sepsis was diagnosed. AGI was evaluated every day during hospitalization, and the highest value was selected and added to the pSOFA score to get the joint score. Multivariate Logistic regression was used to identify the independent factors affecting the outcome. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of pSOFA, AGI grade and their combination for poor prognosis. Results: Among the 143 patients, there were 103 cases (72.1%) in the sepsis group and 40 cases (27.9%) in the septic shock group. The number of patients who received continuous renal replacement therapy, surgery, mechanical ventilation, bloody stool, hypoactive bowel sound and procalcitonin concentration in the septic shock group were higher than those in the sepsis group (P<0.05). The red blood cell, hemoglobin and platelet in the septic shock group were lower than those in the sepsis group (P<0.05). Multivariate Logistic regression analysis showed that mechanical ventilation, surgery, decrease of hemoglobin, increase of pSOFA and AGI grade were the independent risk factors for poor prognosis in patients (P < 0.05). ROC curve analysis showed that the predictive value of pSOFA combined with AGI grading for the prognosis of patients was higher than that of them alone (P<0.05) . Conclusion: Mechanical ventilation, surgery, hemoglobin, pSOFA and AGI classification are prognostic factors of sepsis complicated with AGI in children. The pSOFA combined with AGI grade has a high value in predicting the poor prognosis.
钱新阳、王育民
临床医学儿科学内科学
儿科脓毒症胃肠疾病预后
pediatricssepsis gastrointestinaldisorders prognosis.
钱新阳,王育民.pSOFA评分联合AGI分级评估脓毒症患儿预后的价值[EB/OL].(2024-10-12)[2025-08-16].https://www.biomedrxiv.org.cn/article/doi/bmr.202411.00002.点此复制
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