Zhonghua wei zhong bing ji jiu yi xue · 2026
[Prognostic value of dynamic monitoring of different pediatric critical illness scales in children with extracorporeal membrane oxygenation assisted shock treatment].
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Xue Yingying, Jia Wanyu, Zhang Xue, Quan Xueli, Li Peng, Song Chunlan, Wang Jie, Cheng Yibing
Аннотация
OBJECTIVE: To investigate the predictive value of different pediatric critical illness scores for the prognosis of children with refractory shock receiving extracorporeal membrane oxygenation (ECMO) auxiliary treatment.
METHODS: A retrospective case-control study was conducted. Pediatric patients admitted to the pediatric cardiac and thoracic surgery intensive care unit (ICU) at Henan Children's Hospital from January 2019 to December 2023 who received veno-arterial ECMO support for refractory shock were included. Clinical data were collected. The Pediatric Critical Illness Score (PCIS), PEdiatric Logistic Organ Dysfunction-2 (PELOD-2), and Pediatric Multiple Organ Dysfunction Score (P-MODS) were calculated based on vital signs and laboratory results at 24 hours before ECMO as well as 6 hours and 12 hours of ECMO. Pediatric patients were categorized into death and survival groups according to discharge outcomes. Differences in clinical data and the three scores between groups were compared. Receiver operator characteristic curve (ROC curve) analysis was used to assess the predictive value of the three scores for in-hospital death in ECMO-treated pediatric patients with shock. The Hosmer-Lemeshow goodness-of-fit test was used to evaluate the predictive accuracy of the three scoring systems for death.
RESULTS: A total of 35 pediatric patients with shock were ultimately included. Among them, 23 (66%) successfully weaned off ECMO. At discharge, 18 cases survived (51%), while 17 died (49%). As the duration of ECMO treatment increased, both the survival and death groups showed a gradual increase in PCIS scores, while PELOD-2 and P-MODS scores tended to decrease. Pediatric patients in the death group had lower PCIS scores than the survival group at all the time points before and on ECMO (24 hours before ECMO: 72.00±1.87 vs. 78.22±1.87, 6 hours of ECMO: 75.53±2.15 vs. 81.89±1.35, 12 hours of ECMO: 77.76±1.35 vs. 85.00±1.53, all P<0.05), and PELOD-2 scores were higher than those in the survival group [24 hours before ECMO: 13.00 (10.50, 17.50) vs. 8.50 (6.00, 11.25), 6 hours of ECMO: 13.00 (8.50, 17.00) vs. 9.00 (7.75, 10.75), 12 hours of ECMO: 8.00 (7.00, 13.50) vs. 6.00 (5.00, 8.00), all P<0.05]. Pediatric patients in the death group had higher P-MODS scores at 6 hours and 12 hours of ECMO as compared with the survival group (6 hours of ECMO: 7.94±0.52 vs. 5.61±0.55, 12 hours of ECMO: 5.29±0.71 vs. 3.22±0.44, both P<0.05). The differences in the three scores between 6 hours and 12 hours of ECMO were not statistically significant between groups. ROC curve analysis indicated that the PCIS, PELOD-2, P-MODS scores at 6 hours and 12 hours of ECMO had predictive value for in-hospital death in pediatric patients with shock receiving ECMO support. The 6-hour P-MODS score and 12-hour PELOD-2 score demonstrated the highest predictive accuracy, with combined use of all three scoring systems yielding greater predictive value, the area under the ROC curve (AUC) of 6 hours was 0.809 [95% confidence interval (95%CI) was 0.652-0.965], with sensitivities and specificities of 83.33% and 70.59%, respectively; the AUC of 12 hour was 0.892 (95%CI was 0.780-0.999), with sensitivities and specificities of 94.12% and 72.22%, respectively. The Hosmer-Lemeshow goodness-of-fit test indicated that the 6-hour P-MODS score of ECMO provided the best fit for predicting in-hospital death in pediatric patients with shock receiving ECMO support (χ 2=4.010, P=0.675), while the 12-hour PELOD-2 score of ECMO provided the best fit for predicting death (χ 2=1.556, P=0.906).
CONCLUSIONS: PCIS, PELOD-2, and P-MODS scores before and on ECMO demonstrated predictive value and good fit for predicting in-hospital death in children with shock receiving ECMO support, and allow for continuous dynamic monitoring. Combined use of these three scores further enhances predictive value, sensitivity, and specificity.
METHODS: A retrospective case-control study was conducted. Pediatric patients admitted to the pediatric cardiac and thoracic surgery intensive care unit (ICU) at Henan Children's Hospital from January 2019 to December 2023 who received veno-arterial ECMO support for refractory shock were included. Clinical data were collected. The Pediatric Critical Illness Score (PCIS), PEdiatric Logistic Organ Dysfunction-2 (PELOD-2), and Pediatric Multiple Organ Dysfunction Score (P-MODS) were calculated based on vital signs and laboratory results at 24 hours before ECMO as well as 6 hours and 12 hours of ECMO. Pediatric patients were categorized into death and survival groups according to discharge outcomes. Differences in clinical data and the three scores between groups were compared. Receiver operator characteristic curve (ROC curve) analysis was used to assess the predictive value of the three scores for in-hospital death in ECMO-treated pediatric patients with shock. The Hosmer-Lemeshow goodness-of-fit test was used to evaluate the predictive accuracy of the three scoring systems for death.
RESULTS: A total of 35 pediatric patients with shock were ultimately included. Among them, 23 (66%) successfully weaned off ECMO. At discharge, 18 cases survived (51%), while 17 died (49%). As the duration of ECMO treatment increased, both the survival and death groups showed a gradual increase in PCIS scores, while PELOD-2 and P-MODS scores tended to decrease. Pediatric patients in the death group had lower PCIS scores than the survival group at all the time points before and on ECMO (24 hours before ECMO: 72.00±1.87 vs. 78.22±1.87, 6 hours of ECMO: 75.53±2.15 vs. 81.89±1.35, 12 hours of ECMO: 77.76±1.35 vs. 85.00±1.53, all P<0.05), and PELOD-2 scores were higher than those in the survival group [24 hours before ECMO: 13.00 (10.50, 17.50) vs. 8.50 (6.00, 11.25), 6 hours of ECMO: 13.00 (8.50, 17.00) vs. 9.00 (7.75, 10.75), 12 hours of ECMO: 8.00 (7.00, 13.50) vs. 6.00 (5.00, 8.00), all P<0.05]. Pediatric patients in the death group had higher P-MODS scores at 6 hours and 12 hours of ECMO as compared with the survival group (6 hours of ECMO: 7.94±0.52 vs. 5.61±0.55, 12 hours of ECMO: 5.29±0.71 vs. 3.22±0.44, both P<0.05). The differences in the three scores between 6 hours and 12 hours of ECMO were not statistically significant between groups. ROC curve analysis indicated that the PCIS, PELOD-2, P-MODS scores at 6 hours and 12 hours of ECMO had predictive value for in-hospital death in pediatric patients with shock receiving ECMO support. The 6-hour P-MODS score and 12-hour PELOD-2 score demonstrated the highest predictive accuracy, with combined use of all three scoring systems yielding greater predictive value, the area under the ROC curve (AUC) of 6 hours was 0.809 [95% confidence interval (95%CI) was 0.652-0.965], with sensitivities and specificities of 83.33% and 70.59%, respectively; the AUC of 12 hour was 0.892 (95%CI was 0.780-0.999), with sensitivities and specificities of 94.12% and 72.22%, respectively. The Hosmer-Lemeshow goodness-of-fit test indicated that the 6-hour P-MODS score of ECMO provided the best fit for predicting in-hospital death in pediatric patients with shock receiving ECMO support (χ 2=4.010, P=0.675), while the 12-hour PELOD-2 score of ECMO provided the best fit for predicting death (χ 2=1.556, P=0.906).
CONCLUSIONS: PCIS, PELOD-2, and P-MODS scores before and on ECMO demonstrated predictive value and good fit for predicting in-hospital death in children with shock receiving ECMO support, and allow for continuous dynamic monitoring. Combined use of these three scores further enhances predictive value, sensitivity, and specificity.