Application of the mortality risk score for severe hand, foot and mouth disease in children with hand, foot and mouth disease in pediatric intensive care unit / 中国小儿急救医学

ABSTRACT

Objective:To analyze the predictive value of the mortality risk score for severe hand, foot and mouth disease(MRSHFMD) system for the complications and mortality risk of severe hand, foot and mouth disease(HFMD) in children.Methods:This study included 354 children with severe HFMD who admitted in the pediatric intensive care unit(PICU) of Hunan Provincial Children′s Hospital from March 2012 to March 2014.The patients were grouped according to whether they had complicated nervous system damage, pulmonary edema, pulmonary hemorrhage and circulatory failure in the course of disease, and the prognosis was grouped according to their 28 d survival.The worst values of white blood cell count, blood glucose, blood lactic acid, N-terminal pro-brain natriuretic peptide, within 24 hours after admission were used to score MRSHFMD.The predictive value of MRSHFMD for nervous system damage, pulmonary edema, pulmonary hemorrhage, circulatory failure, and prognosis were evaluated using the receiver operating characteristic(ROC)curve.Results:The blood glucose, white blood cell count, blood lactic acid value, N-terminal pro-brain natriuretic peptide and MRSHFMD score of the children with HFMD complicated with nervous system damage, pulmonary edema, pulmonary hemorrhage and circulatory failure were significantly higher than those in the non-complicated groups( P<0.01). When the cut-off value of MRSHFMD score was 3, the area (95% CI) under the ROC curve were 0.723 (0.643-0.804), 0.870 (0.793-0.946), 0.921 (0.85-0.992), 0.944 (0.867-1.000) and 0.954 (0.000-1.000) of nervous system damage, pulmonary edema, pulmonary hemorrhage, circulation failure and death in children with HFMD, respectively.The specificity and sensitivity of predicting nervous system damage, pulmonary edema, pulmonary hemorrhage, circulatory failure and death were 44.6% and 95.8%; 67.5% and 95.5%; 83.3% and 95.1%; 89.3% and 95.1%; 90.9% and 93.7%, respectively. Conclusion:MRSHFMD system is an effective tool to predict HFMD complications of pulmonary hemorrhage, circulatory failure, and death, which is worthy of clinical promotion.