Risk factors associated with death in children with severe pneumonia admitted to the pediatric intensive care unit and the predictive value of the modified PIRO scale for assessing the risk of mortality
10.3760/cma.j.cn101070-20240118-00038
- VernacularTitle:重症医学科重症肺炎患儿死亡的危险因素分析及改良PIRO评分量表对死亡风险的预测价值
- Author:
Shihua XIANG
1
;
Donghong PENG
Author Information
1. 重庆医科大学附属儿童医院呼吸科，国家儿童健康与疾病临床医学研究中心，儿童发育疾病研究教育部重点实验室，儿科学重庆市重点实验室，重庆 400014
- Keywords:
Child;
Pediatric intensive care unit;
Modified PIRO scale;
Severe pneumonia;
Mortality risk prediction
- From:
Chinese Journal of Applied Clinical Pediatrics
2024;39(9):672-677
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the risk factors associated with death in children with severe pneumonia admitted to the pediatric intensive care unit (PICU), investigate the predictive value of the modified PIRO (mPIRO) scale in assessing the risk of death in these children, and improve the scale appropriately.Methods:In this case-control study, a retrospective analysis was conducted on the clinical data of 460 children with severe pneumonia in the PICU at Children′s Hospital of Chongqing Medical University from May 2015 to December 2021.Based on the occurrence of death, these children were divided into a survival group ( n=411) and a death group ( n=49).Logistic regression analysis was performed to identify the risk factors associated with death in children with severe pneumonia in the PICU.The mPIRO scale was employed to evaluate the mortality risk, wherein the pulse oxygen saturation (SpO 2)<0.90 of the scale was revised to the ratio of SpO 2/fraction of inspired oxygen≤160 to form the modified scale.The predictive effect of both scales was compared using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Results:The Logistic regression analysis revealed hypotension, acute hepatic failure, acute kidney injury, acute respiratory distress syndrome, and elevated blood glucose were independent risk factors for death in children with severe pneumonia in the PICU (all P<0.05).The ROC curve demonstrated that the area under the curve (AUC) of the modified scale was 0.747, significantly higher than that of the mPIRO scale (AUC=0.718, P<0.05).The calibration curve illustrated that the modified scale had a better fit between the predicted result and the actual result.The DCA revealed that the modified scale had a higher net benefit compared to the mPIRO scale at probability thresholds of 0.1 to 0.4. Conclusions:Hypotension, acute hepatic failure, acute kidney injury, acute respiratory distress syndrome, and elevated blood glucose are identified as independent risk factors for death in children with severe pneumonia in the PICU.Both the mPIRO scale and the modified scale show predictive value in assessing mortality risk for children with severe pneumonia in the PICU, with the modified scale demonstrating superior performance.
