小柯机器人

美国科罗拉多大学医学院Tellen D. Bennett团队开发和验证了儿童败血症和感染性休克的新临床标准。这一研究成果于2024年1月21日发表在《美国医学会杂志》上。

重症医学会儿科脓毒症定义工作组试图通过数据驱动的方法，利用器官功能障碍的测量，开发和验证儿科脓毒病和脓毒症休克的新临床标准，旨在推导和验证不同资源环境下儿童败血症和感染性休克的新标准。

研究组在美国、哥伦比亚、孟加拉国、中国和肯尼亚的10个卫生系统中进行了一项多中心国际回顾性队列研究，其中3个被用作外部验证点。数据收集自2010年至2019年儿童（18岁以下）的急诊和住院情况：3049699名在开发（包括推导和内部验证）集，581317名在外部验证集。使用8个现有评分中表现最好的器官功能障碍分量表，推导并验证了用于预测疑似感染儿童死亡率的暴露堆积回归模型。然后将最终模型转换为基于整数的评分，用于建立败血症和感染性休克的二元标准。所有分析的主要结局是住院死亡率。基于模型和整数的得分性能指标包括准确度-召回曲线下的面积（AUPRC；主要）和受试者工作特征曲线下面积（AUROC；次要）。对于二元标准，主要性能指标是阳性预测值和敏感性。

172984名在最初24小时内疑似感染的儿童中（开发集；1.2%的死亡率），4-器官系统模型表现最好。该模型的整数版本，即Phoenix脓毒症评分，预测验证集中死亡率的AUPRC为0.23至0.38（95%置信区间，0.20-0.39），AUROC为0.71至0.92（95%置信范围，0.70-0.92）。与2005年国际儿科脓毒症共识会议（IPSCC）标准相比，在不同资源的环境中，在疑似感染的儿童中使用2分或更高的Phoenix脓毒症评分作为脓毒症的标准，并使用脓毒症加上1分或更多的心血管评分作为脓毒性休克的标准，可获得更高的阳性预测值和更高或相似的敏感性。

研究结果表明，使用来自较高和较低资源环境的数据推导和验证的新的Phoenix败血症标准，与现有的IPSCC标准相比，在诊断儿童败血症和感染性休克方面的表现有所改善。

附：英文原文

Title: Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock

Author: L. Nelson Sanchez-Pinto, Tellen D. Bennett, Peter E. DeWitt, Seth Russell, Margaret N. Rebull, Blake Martin, Samuel Akech, David J. Albers, Elizabeth R. Alpern, Fran Balamuth, Melania Bembea, Mohammod Jobayer Chisti, Idris Evans, Christopher M. Horvat, Juan Camilo Jaramillo-Bustamante, Niranjan Kissoon, Kusum Menon, Halden F. Scott, Scott L. Weiss, Matthew O. Wiens, Jerry J. Zimmerman, Andrew C. Argent, Lauren R. Sorce, Luregn J. Schlapbach, R. Scott Watson, Society of Critical Care Medicine Pediatric Sepsis Definition Task Force, Paolo Biban, Enitan Carrol, Kathleen Chiotos, Claudio Flauzino De Oliveira, Mark W. Hall, David Inwald, Paul Ishimine, Michael Levin, Rakesh Lodha, Simon Nadel, Satoshi Nakagawa, Mark J. Peters, Adrienne G. Randolph, Suchitra Ranjit, Daniela Carla Souza, Pierre Tissieres, James L. Wynn

Issue&Volume: 2024-01-21

Abstract:

Importance  The Society of Critical Care Medicine Pediatric Sepsis Definition Task Force sought to develop and validate new clinical criteria for pediatric sepsis and septic shock using measures of organ dysfunction through a data-driven approach.

Objective  To derive and validate novel criteria for pediatric sepsis and septic shock across differently resourced settings.

Design, Setting, and Participants  Multicenter, international, retrospective cohort study in 10 health systems in the US, Colombia, Bangladesh, China, and Kenya, 3 of which were used as external validation sites. Data were collected from emergency and inpatient encounters for children (aged <18 years) from 2010 to 2019: 3049699 in the development (including derivation and internal validation) set and 581317 in the external validation set.

Exposure  Stacked regression models to predict mortality in children with suspected infection were derived and validated using the best-performing organ dysfunction subscores from 8 existing scores. The final model was then translated into an integer-based score used to establish binary criteria for sepsis and septic shock.

Main Outcomes and Measures  The primary outcome for all analyses was in-hospital mortality. Model- and integer-based score performance measures included the area under the precision recall curve (AUPRC; primary) and area under the receiver operating characteristic curve (AUROC; secondary). For binary criteria, primary performance measures were positive predictive value and sensitivity.

Results  Among the 172984 children with suspected infection in the first 24 hours (development set; 1.2% mortality), a 4-organ-system model performed best. The integer version of that model, the Phoenix Sepsis Score, had AUPRCs of 0.23 to 0.38 (95% CI range, 0.20-0.39) and AUROCs of 0.71 to 0.92 (95% CI range, 0.70-0.92) to predict mortality in the validation sets. Using a Phoenix Sepsis Score of 2 points or higher in children with suspected infection as criteria for sepsis and sepsis plus 1 or more cardiovascular point as criteria for septic shock resulted in a higher positive predictive value and higher or similar sensitivity compared with the 2005 International Pediatric Sepsis Consensus Conference (IPSCC) criteria across differently resourced settings.

Conclusions and Relevance  The novel Phoenix sepsis criteria, which were derived and validated using data from higher- and lower-resource settings, had improved performance for the diagnosis of pediatric sepsis and septic shock compared with the existing IPSCC criteria.

DOI: 10.1001/jama.2024.0196

Source: https://jamanetwork.com/journals/jama/fullarticle/2814296

JAMA-Journal of The American Medical Association：《美国医学会杂志》，创刊于1883年。隶属于美国医学协会，最新IF：157.335
官方网址：https://jamanetwork.com/
投稿链接：http://manuscripts.jama.com/cgi-bin/main.plex