动态预测的死亡率使用纵向测量儿科序列器官衰竭评估得分:一个联合建模方法
Alireza Akhondi-Asl1,2,3,4, Alon Geva1,2,3,4, Jeffrey P Burns1,2,3,4
1Division of Critical Care Medicine, Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA.
概括
与静态入院评分相比,长度儿科序列器官衰竭评估 (pSOFA) 评分,随着时间的推移跟踪变化,显著改善了危急儿童的死亡率预测. 这种动态方法可以更准确地评估患者的病情和PICU治疗的反应.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 临床信息学是一种临床信息学.
- 生物统计学 生物统计学
背景情况:
- 儿科序列器官衰竭评估 (pSOFA) 评分对于评估疾病严重程度和预测重症儿童的死亡率至关重要.
- 目前在一个时间点进行的静态pSOFA评估未能在儿科重症监护室 (PICU) 停留期间捕捉患者状况变化和治疗反应.
- 需要采用动态方法来提高儿科重症监护中死亡率预测的准确性.
研究的目的:
- 评估纵向 (时间变化) pSOFA 评分的性能,以预测严重病症儿童30天住院死亡率.
- 为了比较动态pSOFA评分的预测准确性与传统的静态录取pSOFA评分.
主要方法:
- 追溯队列研究涉及9146名患者,他们在2015年至2021年期间入院于四级40个床位的PICU,至少在ICU停留24小时.
- 每天的pSOFA分数被计算到30天或直到退院/死亡.
- 用一个联合的纵向和时间到事件数据模型来进行动态死亡率预测,数据集被随机划分为培训 (75%) 和验证 (25%) 的子集,使用重复分层交叉验证.
主要成果:
- 研究数据集包括9146名患者,30天住院死亡率为2.6%.
- 从前3天的纵向pSOFA分数与入院分数相比,提高了死亡率预测曲线下动态面积 (AUC) 的6.4%.
- 使用从前5天的纵向pSOFA得分,在第5天到30天之间的死亡率预测中,AUC进一步提高了9.2%.
结论:
- 与传统的入院日pSOFA得分相比,纵向的pSOFA得分在预测PICU患者的死亡率方面表现出更高的准确性.
- 动态应用pSOFA分数具有显著的潜力,可以更精确地持续评估重症监护机构中的患者状况.
- 这项研究强调了动态风险评估在儿科重症监护中的价值,以改善患者的治疗结果.
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