CAJ | 학술논문

目的：应用儿童死亡风险评分(pediatric risk of mortality score,PRISM)评估重症手足口病患儿的病情严重程度,探讨PRISM对重症手足口病患儿并发肺出血及死亡风险的预测能力。方法选取于2010年1月至2013年6月入住我院重症监护室的符合重症手足口病诊断标准的424例患儿。收集PRISM的相关生理参数及结局资料,通过受试者工作特征曲线(receiver operating characteristic, ROC)下的面积来评估PRISM对肺出血及死亡和存活的分辨力,Hosmer-Lemeshow拟合优度检验来评估预期病死率和实际病死率是否拟合。结果 PRISM分辨是否发生肺出血的ROC曲线下面积为0.87(95%CI：0.80~0.94),PRISM分辨是否发生死亡的ROC曲线下面积0.87(95%CI：0.80~0.95)；通过Hosmer-Lemeshow拟合优度检验来评价模型的准确度发现：PRISM预测肺出血发生人数和实际发生人数存在差异(χ2=36.66,P<0.001)；PRISM预测死亡人数和实际死亡人数存在差异(χ2=41.11,P<0.001)。结论 PRISM对重症手足口病患儿合并肺出血及死亡风险评估具有较好的分辨力,但是拟合性欠佳。
목적：응용인동사망풍험평분(pediatric risk of mortality score,PRISM)평고중증수족구병환인적병정엄중정도,탐토PRISM대중증수족구병환인병발폐출혈급사망풍험적예측능력。방법선취우2010년1월지2013년6월입주아원중증감호실적부합중증수족구병진단표준적424례환인。수집PRISM적상관생리삼수급결국자료,통과수시자공작특정곡선(receiver operating characteristic, ROC)하적면적래평고PRISM대폐출혈급사망화존활적분변력,Hosmer-Lemeshow의합우도검험래평고예기병사솔화실제병사솔시부의합。결과 PRISM분변시부발생폐출혈적ROC곡선하면적위0.87(95%CI：0.80~0.94),PRISM분변시부발생사망적ROC곡선하면적0.87(95%CI：0.80~0.95)；통과Hosmer-Lemeshow의합우도검험래평개모형적준학도발현：PRISM예측폐출혈발생인수화실제발생인수존재차이(χ2=36.66,P<0.001)；PRISM예측사망인수화실제사망인수존재차이(χ2=41.11,P<0.001)。결론 PRISM대중증수족구병환인합병폐출혈급사망풍험평고구유교호적분변력,단시의합성흠가。
Objective To comment the severity of severe hand,foot and mouth disease(HFMD)by pediatric risk of mortality score(PRISM),and assess the performance of PRISM in predicting mortality or complication probability in HFMD.Methods Four hundred and twenty-four severe HFMD pediatric patients were recruited in the study from 1th Jan 2010 to 31th June 2013.Information on the outcome and the varia-bles required to calculate PRISM score were collected.The logistic regression model developed in the learning sample was evaluated in the test sample by calculating the area under the receiver operating characteristic (ROC)curve to assess discrimination pneumorrhagia and death.Calibration across deciles of risk was evalua-ted using the Hosmer-Lemeshow goodness-of-fit χ2 test.Results The area under the ROC curve were 0.87 (95%CI 0.80~0.94 )for PRISM in predicting pneumorrhagia probability.The area under the ROC curve were 0.87(95%CI 0.80~0.95)for PRISM in predicting mortality probability.The PRISM in observed and expected pneumorrhagia did not demonstrate good calibration at ten mortality risk intervals (χ2 =36.66, P<0.001 ).The PRISM in observed and expected mortality did not demonstrate good calibration at ten mortali-ty risk intervals(χ2 =41.11,P<0.001).Conclusion The PRISM score is demonstrated good discrimination of pneumorrhagia and death in HFMD pediatric patients,but the performance of calibration is not good.