本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.0196

摘要内容如下：

重要性

重症监护医学学会儿科脓毒症定义工作组试图通过数据驱动的方法，使用器官功能障碍的测量来开发和验证儿科脓毒症和脓毒性休克的新临床标准。

目的

在不同的资源环境中推导并验证儿科脓毒症和脓毒性休克的新标准。

设计、设置和参与者

在美国、哥伦比亚、孟加拉国、中国和肯尼亚的10个卫生系统进行的多中心、国际、回顾性队列研究，其中3个被用作外部验证点。从2010年至2019年的儿童（年龄<18岁）急诊和住院患者中收集数据：开发（包括推导和内部验证）集中为3049699，外部验证集中为581317。

曝光

使用8个现有评分中表现最好的器官功能障碍分项评分，推导并验证了预测疑似感染儿童死亡率的叠加回归模型。然后将最终模型转化为基于整数的评分，用于建立脓毒症和脓毒性休克的二元标准。

主要成果和措施

所有分析的主要结果是住院死亡率。基于模型和整数的评分性能指标包括精确度-召回率曲线下面积（AUPRC；主要）和受试者工作特征曲线下面积（AUROC；次要的）。对于二元标准，主要性能指标为阳性预测值和敏感性。

结果

在第一个24小时内疑似感染的172984名儿童中（发展组；死亡率为1.2%），4器官系统模型表现最佳。该模型的整数版本，即Phoenix脓毒症评分，AUPRCs为0.23至0.38（95%CI范围，0.20-0.39），AUROCs为0.71至0.92（95%CI范围，0.70-0.92），可预测验证组的死亡率。与2005年国际儿科脓毒症共识会议（IPSCC）标准相比，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，以及脓毒症加1个或更多的心血管评分作为脓毒症休克的标准，在不同的资源环境中产生了更高的阳性预测值和更高或相似的敏感性。

结论和相关性

与现有的IPSCC标准相比，新的Phoenix脓毒症标准在儿科脓毒症和脓毒性休克的诊断方面具有更好的性能，该标准是使用来自较高和较低资源环境的数据推导和验证的。

英文原文如下：

Abstracts

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: 3 049 699 in the development (including derivation and internal validation) set and 581 317 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 172 984 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.

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