突发公共卫生事件对mPIRO量表预测儿童社区获得性肺炎预后性能的影响

The Impact of Public Health Emergencies on the Prognostic Performance of the mPIRO Scale in Predicting Community-Acquired Pneumonia in Children

摘要: 目的：探索新型冠状病毒肺炎这一突发公共卫生事件对改良PIRO (mPIRO)量表预测社区获得性肺炎(Community-Acquired Pneumonia, CAP)患儿预后性能的影响。方法：回顾性地收集了2016年至2021年入住重庆医科大学附属儿童医院诊断为CAP患儿资料，并分为两部分，2016年至2019年为疫情前，2020年至2021年为疫情后，研究关注的不良预后为CAP患儿住院期间死亡、转入ICU或使用有创呼吸机治疗。分别计算疫情前后mPIRO量表预测CAP患儿不良预后的特异度、敏感度及受试者工作特征曲线下面积(AUC)，作为量表区分性能评价标准；并疫情前后比较mPIRO量表反应的病情变化与CAP患儿实际变化情况。从以上两方面来分析突发公共卫生事件对mPIRO量表预测性能的影响。结果：疫情前后mPIRO量表预测CAP患儿不良预后的性能始终优良。具体来说，预测死亡时的AUC分别为0.87 vs. 0.84，特异度分别为73.1% vs. 74.9%，敏感度分别为86.3% vs. 78.6%；预测转入ICU的AUC分别为0.87 vs. 0.84，特异度分别为73.1% vs. 76.4%，敏感度分别为85.0% vs. 85.0%；预测使用有创呼吸机风险的AUC分别为0.88 vs. 0.88，特异度分别为75.25% vs. 76.4%，敏感度分别为85.92% vs. 85.16%。并且mPIRO量表反应的病情严重变化与实际不良预后变化是一致的。结论：mPIRO量表预测性能不被公共卫生突发事件影响，在后疫情时代，mPIRO量表仍然可作为一种可靠的决策辅助工具，指导儿科医师对有高不良预后风险的患儿采取更积极治疗措施。

Abstract: Objective: This study aims to investigate the influence of COVID-19, a public health emergency, on the prognostic performance of the Modified PIRO (mPIRO) scale in children with Community Acquired Pneumonia (CAP). Methods: We retrospectively collected data on children diagnosed with CAP admitted to the Children’s Hospital of Chongqing Medical University between 2016 and 2021. The data were divided into two groups: pre-epidemic (2016~2019) and post-epidemic (2020~2021). Poor prognosis was defined as in-hospital mortality, admitted to the ICU, and/or use of invasive mechanical ventilation in children with CAP. The specificity, sensitivity, and area under the receiver operating characteristic curve (AUC) of the mPIRO scale for predicting poor prognosis were calculated for both pre-epidemic and post-epidemic periods to evaluate the scale’s discriminatory ability. Evaluate the concordance between the changes in mPIRO score-reflected disease severity and the actual clinical severity of CAP in children before and after the COVID-19 pandemic. These two analyses were used to assess the impact of the public health emergency on the predictive performance of the mPIRO scale. Results: The mPIRO scale demonstrated consistently good performance in predicting various adverse outcomes in children with CAP before and after the epidemic. For mortality, the AUC was 0.87 vs. 0.84, specificity was 73.1% vs. 74.9%, and sensitivity was 86.3% vs. 78.6%. Similarly, the AUC for predicting ICU admission was 0.87 vs. 0.84, with specificity of 73.1% vs. 76.4% and sensitivity of 85.0% for both periods. The mPIRO scale also performed well in predicting invasive ventilator use, with AUCs of 0.88 for both periods, specificity of 75.25% vs. 76.4%, and sensitivity of 85.92% vs. 85.16%. Notably, the changes in mPIRO scores mirrored the changes in actual adverse outcomes. Conclusions: Our findings suggest that the mPIRO scale’s predictive performance remains unaffected by public health emergencies. This indicates that even in the post-pandemic era, the mPIRO scale can continue to serve as a reliable decision-making tool for pediatricians. It can effectively guide them in implementing more aggressive treatment measures for children identified as high-risk for poor outcomes.