4 research outputs found
Multicenter validation of PIM3 and PIM2 in Brazilian pediatric intensive care units
ObjectiveTo validate the PIM3 score in Brazilian PICUs and compare its performance with the PIM2.MethodsObservational, retrospective, multicenter study, including patients younger than 16 years old admitted consecutively from October 2013 to September 2019. We assessed the Standardized Mortality Ratio (SMR), the discrimination capability (using the area under the receiver operating characteristic curve – AUROC), and the calibration. To assess the calibration, we used the calibration belt, which is a curve that represents the correlation of predicted and observed values and their 95% Confidence Interval (CI) through all the risk ranges. We also analyzed the performance of both scores in three periods: 2013–2015, 2015–2017, and 2017–2019.Results41,541 patients from 22 PICUs were included. Most patients aged less than 24 months (58.4%) and were admitted for medical conditions (88.6%) (respiratory conditions = 53.8%). Invasive mechanical ventilation was used in 5.8%. The median PICU length of stay was three days (IQR, 2–5), and the observed mortality was 1.8% (763 deaths). The predicted mortality by PIM3 was 1.8% (SMR 1.00; 95% CI 0.94–1.08) and by PIM2 was 2.1% (SMR 0.90; 95% CI 0.83–0.96). Both scores had good discrimination (PIM3 AUROC = 0.88 and PIM2 AUROC = 0.89). In calibration analysis, both scores overestimated mortality in the 0%–3% risk range, PIM3 tended to underestimate mortality in medium-risk patients (9%–46% risk range), and PIM2 also overestimated mortality in high-risk patients (70%–100% mortality risk).ConclusionsBoth scores had a good discrimination ability but poor calibration in different ranges, which deteriorated over time in the population studied
Análise de acurácia de diferentes escores de morbimortalidade para pretermos abaixo de 1000g
Submitted by Luis Guilherme Macena ([email protected]) on 2013-04-08T12:59:39Z
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Previous issue date: 2012Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, BrasilINTRODUÇÃO: Atualmente, cada vez maior é o interesse por indicadores para a
avaliação de risco de óbito de RNs, principalmente em prematuros. Entretanto,
escores como CRIB, CRIB II e SNAPPE II, e outros marcadores como a
Troponina CardÃaca ainda não podem ser considerados como bons preditores
para essa população.
OBJETIVO: Determinar a acurácia de diferentes escores (CRIB, CRIB II e
SNAPPE II) e da Troponina CardÃaca como marcadores de mortalidade e
sobrevida com sequelas em RNs com peso de nascimento menor de 1000g.
MATERIAL E MÉTODOS: Foram incluÃdos no estudo todos os RNs com peso de
nascimento inferior a 1000g nascidos e admitidos na UTIN da ClÃnica Perinatal de
Laranjeiras e do Instituto Fernandes Figueira/FIOCRUZ, no perÃodo maio de 2006
a maio de 2011. Foi realizada uma coleta de dados retrospectiva dos dados da
gestação, do parto e do nascimento, e da internação até a Alta ou Óbito. Foram
realizados testes estatÃsticos para diferenças de médias (teste t de Student) e de
proporções (Qui-quadrado), medidas das áreas abaixo das Curvas ROC (Az) dos
escores e Análise de Regressão LogÃstica.
RESULTADOS: Os escores CRIB, CRIB II e SNAPPE II são bons preditores de
mortalidade em menores de 1000g (Az 0,815; 0,835; 0,834 p-valor<0,001).
Contudo, apenas os escores CRIB II e SNAPPE II são bons preditores de
sobrevida sem sequelas (Az 0,709 e 0,737 p-valor<0,001). A Troponina CardÃaca
positiva aumenta em três vezes o risco de óbito neonatal (OR: 3,15 p-valor: 0,017)
e apresentou associação com acidose metabólica (OR: 2,88 p-valor: 0,02),
APGAR 5º minuto menor que 7 (OR: 10,06 p-valor: 0,01), PCA (OR: 4,23 p-valor:
0,005) e HIC Graus III e IV (OR: 4,56 p-valor: 0,034). No Modelo de Regressão
LogÃstica, observou-se que Sepse Neonatal comprovada (OR: 11,96 p-valor:
0,008), Enterocolite Necrosante (OR: 14,07 p-valor: 0,006) e Hemorragia
Intracraniana (OR: 7,95 p-valor: 0,003) aumentam a chance de o RN evoluir ao
óbito. Observou-se também que os RNs pequenos para a idade gestacional (OR:
12,35 p-valor: 0,036), do sexo masculino (OR: 8,19 p-valor: 0,005) ou que
necessitaram de mais que duas doses de Surfactante exógeno (OR: 8,73 p-valor:
0,012) tiveram mais chance de sobreviver com sequelas. Na Análise de
Regressão LogÃstica, apenas o SNAPPE II apresentou associação com os
desfechos estudados.
CONCLUSÃO: Os escores CRIB, CRIB II e SNAPPE II são bons preditores de
mortalidade, e CRIB II e SNAPPE II também se revelaram bons preditores de
sobrevida com sequelas. Após a Análise de Regressão LogÃstica, apenas o
SNAPPE II demonstrou ter associação com ambos desfechos, sendo considerado
o melhor marcador de mortalidade e sobrevida com sequelas para a população de
RNs com peso de nascimento menor de 1000g.BACKGROUND: Currently, there is an increasing interest in identify indicators for
assessing risk of death in newborns, especially premature infants. Despite known
scores as CRIB, CRIB II and SNAPPE II, and anothers as cardiac troponin, none
of them are considered as good preditors for this population.
OBJECTIVE: To determine the accuracy of different scores (CRIB, CRIB
SNAPPE II and II) and cardiac troponin as markers of mortality and survival with
sequelae in newborns with birth weight under 1000g.
MATERIALS AND METHODS: The study included all newborns with birth weight
less than 1000g born and admitted to the NICU Perinatal Laranjeiras Clinic and
the Fernandes Figueira Institute / FIOCRUZ in the period May 2006 to May 2011.
We performed a retrospective data collection of the data of pregnancy, labor and
birth, and hospitalization until discharge or death. Statistical tests were performed
for differences in means (t-test), and proportions (chi-square test), measuring of
area under the ROC curve (AUC) of scores and logistic regression analysis.
RESULTS: Scores CRIB, CRIB II and SNAPPE II are good predictors of mortality
in newborns under birth weight under 1000g (AUC 0,815 and 0,835 and 0,834 pvalor<
0,001). However, only the scores SNAPPE II and CRIB II were good
performances as predictors of survival with sequelae in our samples (AUC 0,709
and 0,737 p-valor<0,001). Cardiac Troponin positive increases at three times the
risk of neonatal death (OR: 3,15 p-valor: 0,017) and was associated with metabolic
acidosis (OR: 2,88 p-valor: 0,02), five-minute Apgar score of less than 7 (OR:
10,06 p-valor: 0,01), PDA (OR: 4,23 p-valor: 0,005) and HIC Grades III and IV
(OR: 4,56 p-valor: 0,034). In the Logistic Regression Model, it was observed that
proven neonatal sepsis (OR = 11.96 p-value: 0.008), necrotizing enterocolitis (OR
= 14.07 p-value: 0.006) and intracranial hemorrhage (OR: 7.95 p -value: 0.003)
increases the chance of an infant death evolve. It was also observed that the
newborns small for gestational age (OR = 12.35 p-value: 0.036), male (OR: 8.19
p-value: 0.005) or who required more than two doses of surfactant exogenous
(OR: 8.73 p-value: 0.012) were more likely to survive with sequelae. After logistic
regression analysis, only SNAPPE II was associated with the outcomes studied.
CONCLUSION: The scores CRIB, CRIB II and II SNAPPE are good predictors of
mortality, and CRIB II and II SNAPPE also proved good predictors of survival with
sequelae. After logistic regression analysis, only the SNAPPE II demonstrated
good association with both outcomes being considered the best marker of
mortality and survival with consequences for the population of newborns with birth
weight under 1000g
Datasheet1_Multicenter validation of PIM3 and PIM2 in Brazilian pediatric intensive care units.pdf
ObjectiveTo validate the PIM3 score in Brazilian PICUs and compare its performance with the PIM2.MethodsObservational, retrospective, multicenter study, including patients younger than 16 years old admitted consecutively from October 2013 to September 2019. We assessed the Standardized Mortality Ratio (SMR), the discrimination capability (using the area under the receiver operating characteristic curve – AUROC), and the calibration. To assess the calibration, we used the calibration belt, which is a curve that represents the correlation of predicted and observed values and their 95% Confidence Interval (CI) through all the risk ranges. We also analyzed the performance of both scores in three periods: 2013–2015, 2015–2017, and 2017–2019.Results41,541 patients from 22 PICUs were included. Most patients aged less than 24 months (58.4%) and were admitted for medical conditions (88.6%) (respiratory conditions = 53.8%). Invasive mechanical ventilation was used in 5.8%. The median PICU length of stay was three days (IQR, 2–5), and the observed mortality was 1.8% (763 deaths). The predicted mortality by PIM3 was 1.8% (SMR 1.00; 95% CI 0.94–1.08) and by PIM2 was 2.1% (SMR 0.90; 95% CI 0.83–0.96). Both scores had good discrimination (PIM3 AUROC = 0.88 and PIM2 AUROC = 0.89). In calibration analysis, both scores overestimated mortality in the 0%–3% risk range, PIM3 tended to underestimate mortality in medium-risk patients (9%–46% risk range), and PIM2 also overestimated mortality in high-risk patients (70%–100% mortality risk).ConclusionsBoth scores had a good discrimination ability but poor calibration in different ranges, which deteriorated over time in the population studied.</p