Validation of the Pediatric Index of Mortality 3 in a Single Pediatric Intensive Care Unit in Korea

To compare mortality rate, the adjustment of case-mix variables is needed. The Pediatric Index of Mortality (PIM) 3 score is a widely used case-mix adjustment system of a pediatric intensive care unit (ICU), but there has been no validation study of it in Korea. We aim to validate the PIM3 in a Korean pediatric ICU, and extend the validation of the score from those aged 0–16 to 0–18 years, as patients aged 16–18 years are admitted to pediatric ICU in Korea. A retrospective cohort study of 1,710 patients was conducted in a tertiary pediatric ICU. To validate the score, the discriminatory power was assessed by calculating the area under the receiver-operating characteristic (ROC) curve, and calibration was evaluated by the Hosmer-Lemeshow goodness-of-fit (GOF) test. The observed mortality rate was 8.47%, and the predicted mortality rate was 6.57%. For patients aged < 18 years, the discrimination was acceptable (c-index = 0.76) and the calibration was good, with a χ² of 9.4 in the GOF test (P = 0.313). The observed mortality rate in the hemato-oncological subgroup was high (18.73%), as compared to the predicted mortality rate (7.13%), and the discrimination was unacceptable (c-index = 0.66). In conclusion, the PIM3 performed well in a Korean pediatric ICU. However, the application of the PIM3 to a hemato-oncological subgroup needs to be cautioned. Further studies on the performance of PIM3 in pediatric patients in adult ICUs and pediatric ICUs of primary and secondary hospitals are needed.

Factor VII polymorphisms and stroke / 대한임상병리학회지

BACKGROUND: Factor VII:C (FVII:C) has been shown to be a risk factor of ischemic heart disease (IHD) and plasma levels are reported to be associated with polymorphisms of the FVII gene. Cerebrovascular disease (CVD) shares many of the risk factors associated with IHD but few studies about the relationship between FVII and CVD have been investigated. In this study, we sought to determine the relationship between FVII gene polymorphisms and cerebral infarct in the population below 50 years old. METHODS: The subjects were 78 patients with cerebral infarct who had been admitted between March and December 1999 and 70 controls, matched with age and sex. FVII R353Q and hypervariable region 4 (HVR4) polymorphisms were analyzed with allele specific PCR and restriction enzyme treatment. FVII:C assay was performed on the STAGO Compact analyzer. Total cholesterol and triglycerides were also measured. RESULTS: There was no significant difference in FVII:C, total cholesterol and triglycerides between patients and controls. The distribution of the FVII R353Q genotype and the HVR4 genotype also showed no differences in patients, compared to controls. But both polymorphisms were significantly associated with FVII:C levels in the patients and controls. CONCLUSIONS: The level of FVII:C was related to FVII gene polymorphisms but there is no significant difference of FVII gene polymorphisms in the cerebral infarct population, compared to controls. Our study supports that neither FVII:C levels nor FVII genotypes are independently involved in the pathogenesis of cerebral infarct. In conclusion, the FVII genotype is a major predictor of plasma FVII:C levels but may not play an important role in the development of cerebral infarct.