Modified PIRO (predisposition, insult, response, organ dysfunction) severity score as a predictor for mortality of children with pneumonia in Hasan Sadikin Hospital, Bandung, Indonesia.

IF 2.3 Multidisciplinary Respiratory Medicine Pub Date : 2021-03-10 eCollection Date: 2021-01-15 DOI:10.4081/mrm.2021.735
Vebri Valentania, Dadang H Somasetia, Dany Hilmanto, Djatnika Setiabudi, Heda Melinda N Nataprawira
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引用次数: 5

Abstract

Background: Clinical manifestations for pneumonia vary from mild to severe. The PIRO model (predisposition, insult, response, organ dysfunction) was used as scoring system to determine severity of sepsis and pneumonia in adult patients. The PIRO model was modified for sorting the severity of pneumonia in children and predicting its risk of mortality.

Methods: An ambispective cohort study of pneumonia patients aged 1 month to ≤ 18 years admitted over the period from May to September 2020. Data were collected from history, physical examination, laboratory examination, and chest radiography. Based on bivariate analysis (p<0.05 and relative risk (RR) with 95% confidence interval), variables of each PIRO component that were significant for mortality were assigned a value of 1. The cut-off score for predictor of mortality was calculated using the receiver operating characteristics (ROC) curve and the scores were stratified into three degrees of risk based on interquartile range, score ≤Q1 was categorized as low risk; Q1-Q3 was categorized as moderate risk; and score >Q3 was categorized as high risk.

Results: Out of the 80 subjects enrolled, 6 months-5 years was the largest age group (56.3%). The observed mortality was 15/80 (18.8%). The modified PIRO severity score was compiled from significant variables of predisposition (malnutrition), insult (chest radiograph), response (hypoxemia, hypotension, CRP >0.5 mg/dL, PCT >0.5 ng/dL) and organ dysfunction, with range of score 0-7. Score >3 was categorized as a cut-off point score for predictor of mortality with AUC 0.919 (95% CI 0.836-0.968), sensitivity of 80%, and specificity of 84.62%. Subjects with score >3 have RR of 10.544 compared to those with score ≤3. The stratification of score level was low (≤2), moderate (3-4), and high (5-7). The mortality levels were 0%, 46.7%, and 53.3%, respectively.

Conclusions: Modified PIRO severity score can be used as a sorting tool and predictor of mortality risk in children with pneumonia. This score can also be used to select candidates for intensive care, especially in health facilities with limited intensive care capacity.

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改良的PIRO(易感、侮辱、反应、器官功能障碍)严重程度评分作为印度尼西亚万隆Hasan Sadikin医院肺炎患儿死亡率的预测因子
背景:肺炎的临床表现从轻到重不等。采用PIRO模型(易感、损伤、反应、器官功能障碍)作为评分系统来确定成人患者脓毒症和肺炎的严重程度。对PIRO模型进行了修改,以便对儿童肺炎的严重程度进行分类并预测其死亡风险。方法:对2020年5月至9月住院的1个月至≤18岁的肺炎患者进行双视角队列研究。资料收集自病史、体格检查、实验室检查和胸片。基于双变量分析(pQ3)被归类为高风险。结果:在入组的80名受试者中,6个月至5岁是最大的年龄组(56.3%)。观察死亡率为15/80(18.8%)。修改后的PIRO严重程度评分是根据易感因素(营养不良)、损伤(胸片)、反应(低氧血症、低血压、CRP >0.5 mg/dL、PCT >0.5 ng/dL)和器官功能障碍等显著变量编制的,评分范围为0-7分。评分>3分作为死亡预测指标的截止点评分,AUC为0.919 (95% CI 0.836-0.968),敏感性为80%,特异性为84.62%。得分>3的受试者与得分≤3的受试者相比,RR为10.544。评分水平分层为低(≤2)、中(3-4)、高(5-7)。死亡率分别为0%、46.7%和53.3%。结论:改良的PIRO严重程度评分可作为肺炎患儿死亡风险的分类工具和预测因子。该评分也可用于选择重症监护候选人,特别是在重症监护能力有限的卫生设施中。
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来源期刊
Multidisciplinary Respiratory Medicine
Multidisciplinary Respiratory Medicine Medicine-Pulmonary and Respiratory Medicine
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期刊介绍: Multidisciplinary Respiratory Medicine is the official journal of the Italian Respiratory Society - Società Italiana di Pneumologia (IRS/SIP). The journal publishes on all aspects of respiratory medicine and related fields, with a particular focus on interdisciplinary and translational research. The interdisciplinary nature of the journal provides a unique opportunity for researchers, clinicians and healthcare professionals across specialties to collaborate and exchange information. The journal provides a high visibility platform for the publication and dissemination of top quality original scientific articles, reviews and important position papers documenting clinical and experimental advances.
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