Assessing the accuracy of prognostic scales in children with neuroinfections

Q4 Medicine

Infektsionnye Bolezni Pub Date : 2021-01-01 DOI:10.20953/1729-9225-2021-2-76-82

K. Ermolenko, Saint Petersburg Russian Federation Biological Agency, Y. Aleksandrovich, K. V. Pshenisnov, A. I. Konev, K. V. Serednyakov, I. V. Aleksandrovich, L. Ditkovskaya, E. Pavlovskaia

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引用次数: 2

Abstract

Accurate assessment of the disease severity and outcome prediction in children with neuroinfections is one of the most challenging problems in pediatric intensive care. Objective. To evaluate performance characteristics of several prognostic scales used in children with infections of the central nervous system (CNS). Patients and methods. We examined 100 children with a mean age of 3.5 years. Mean length of stay in the intensive care unit was 9.5 days; mean duration of ventilation was 6.0 days. The death rate was 11%. To evaluate patients’ condition, we used the following scales: PELOD2, PELOD, PRISM3, and pSOFA. Results. We found that 65% of patients had depressed consciousness; 22% of patients had high-grade fever. The stroke volume and ejection fraction were near the lower reference limit, while 20% of children had their ejection fraction ≤ 60%. Leukocytosis was observed in 51 children; 37 children had anemia. Hyponatremia was registered in 17% of cases. Severe hypocoagulation was observed in 7% of cases in patients with generalized meningococcal infection. We found that thrombocytopenia (117 × 109 cells/L) and SpO2/FiO2 ratio <200 mm Hg were the main predictors of death. The рSOFA scale demonstrated the highest accuracy among the scales studied (AUC = 0.717). Conclusion. The рSOFA scale is a highly sensitive and specific scale for the assessment of death risk in children with CNS infections, which allows us to recommend it for routine clinical practice. Key words: CNS infections, children, prognostic scales, PELOD, PELOD-2, рSOFA, SOFA

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评估神经感染儿童预后量表的准确性

神经系统感染患儿疾病严重程度的准确评估和预后预测是儿科重症监护中最具挑战性的问题之一。目标。评估几种用于中枢神经系统(CNS)感染儿童的预后量表的表现特征。患者和方法。我们检查了100名平均年龄为3.5岁的儿童。重症监护病房的平均住院时间为9.5天;平均通气时间为6.0 d。死亡率为11%。为了评估患者的病情，我们使用了以下量表:PELOD2、PELOD、PRISM3和pSOFA。结果。我们发现65%的患者有意识压抑;22%的患者出现高热。卒中容积和射血分数接近参考下限，20%的患儿射血分数≤60%。51例患儿出现白细胞增多;37名儿童患有贫血。17%的病例出现低钠血症。在广泛性脑膜炎球菌感染患者中，有7%的病例出现严重低凝。我们发现血小板减少(117 × 109细胞/L)和SpO2/FiO2比值<200 mm Hg是死亡的主要预测因子。在所研究的量表中，该量表的准确度最高(AUC = 0.717)。结论。对于评估中枢神经系统感染儿童的死亡风险， sofa量表是一种高度敏感和特异性的量表，因此我们推荐将其用于常规临床实践。关键词:中枢神经系统感染，儿童，预后量表，PELOD, PELOD-2， SOFA, SOFA

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来源期刊

Infektsionnye Bolezni Medicine-Infectious Diseases

CiteScore

1.30

自引率

0.00%

发文量

期刊介绍： The journal publishes original research works, reviews of literature, lectures, methodological recommendations, clinical observations. Main topics: problems of etiology, pathogenesis, clinical manifestations of infectious diseases, new techniques and methods of their diagnosis, prevention and treatment; special attention is paid to the problems of antibacterial and antiviral therapy, the use of immunoglobulins and interferons, and also to intensive therapy of critical states. The journal is in the List of leading scientific journals and periodicals of the Supreme Attestation Committee, where the principal results of doctoral dissertations should be published.