Información de la revista
Vol. 57. Núm. 5.
Páginas 394-400 (Noviembre 2002)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 57. Núm. 5.
Páginas 394-400 (Noviembre 2002)
Acceso a texto completo
Valor pronóstico de la puntuación PIM (índice pediátrico de mortalidad) y del ácido láctico en niños críticamente enfermos
Prognostic value of the pediatric index of mortality (PIM) score and lactate values in critically-ill children
Visitas
11769
C. García Sanz, M. Rupérez Lucas, J. López-Herce Cid
Autor para correspondencia
pielvi@eresmas.net

Correspondencia: Arzobispo Morcillo, 52, 9.° C. 28029 Madrid. España.
, D. Vigil Escribano, G. Garrido Cantarero
Sección de Cuidados Intensivos Pediátricos. Unidad de Investigación. Servicio de Medicina Preventiva y Gestión de Calidad. Hospital General Universitario Gregorio Marañón. Madrid. España
Este artículo ha recibido
Información del artículo
Objetivo

Estudiar y comparar el valor pronóstico de la puntuación índice pediátrico de mortalidad (PIM) y el ácido láctico en el momento de ingreso en una unidad de cuidadosintensivos pediátricos (UCIP).

Pacientes y métodos

Se realizó un estudio prospectivo en 500 pacientes consecutivos, 237 niñas (47,4 %) y 263 niños (52,6 %), con una edad media de 51,5 ± 59,7 meses (límites, 3 días-18 años) ingresados en una UCIP. A su ingreso se determinó la puntuación PIM y el ácido láctico en sangre. Se estudió la capacidad predictiva de ambos parámetros en relación a la mortalidad y a la duración de ingreso en la UCIP.

Resultados

Fallecieron 36 pacientes (el 7,2 %). La probabilidad media de muerte de los pacientes fallecidos según la fórmula PIM fue de 23,6% ± 28,9, significativamente superior a la de los supervivientes 3,4% ± 7,3 (p < 0,001). El área bajo la curva ROC para el PIM fue de 0,81 ± 0,03 (intervalo de confianza al 95 % [IC 95 %], 0,74-0,89). La concentración de ácido láctico en los pacientes fallecidos fue de 4,9 ± 3,5 mmol/l, significativamente superior a la de los supervivientes, 1,9 ± 1,5 mmol/l (p < 0,001). El área bajo la curva ROC para el ácido láctico fue de 0,76 ± 0,04 (IC 95 %, 0,67-0,85), sin que existan diferencias estadísticamente significativas entre ambas curvas ROC. En los supervivientes se encontró relación entre la puntuación PIM y la duración del ingreso, mientras que en los pacientes fallecidos existió una relación inversa entre la concentración de ácido láctico y la duración del ingreso en la UCIP.

Conclusiones

Tanto la puntuación PIM como el ácido láctico tienen un aceptable valor pronóstico al ingreso del niño críticamente en la UCIP. La capacidad predictiva de la puntuación PIM es mayor pero es más complicada de obtener, mientras que el ácido láctico es rápido y sencillo.

Palabras clave:
Pronóstico
Gravedad
Mortalidad
Cuidados intensivos pediátricos
Niños críticamente enfermos
Ácido láctico
Índice pediátrico de mortalidad
Objective

To analyze and compare the prognostic value of the pediatric index of mortality (PIM) score and lactate values on admission to a pediatric intensive care unit (PICU).

Patients and methods

We performed a prospective study of 500 consecutive children: 237 girls (47.4 %) and 263 boys (52.6 %) with a mean age of 51.5 ± 59.7 (range: 3 days-18 years) admitted to our PICU. PIM scores and blood lactate concentrations were determined on admission. The predictive ability of PIM and lactate concentrations in relation to mortality and length of stay in the PICU were analyzed.

Results

Thirty-six patients (7.2 %) died. According to the PIM score, the mean probability of death in children who died was 23.6% ± 28.9, which was significantly higher than that in surviving children (3.4% ± 7.3; p < 0.001). The area under the ROC curve for PIM was 0.81 ± 0.03 (95 % CI: 0.74-0.89). Lactate level in nonsurvivors was 4.9% ± 3.5 mmol/L, which was significantly higher than that in survivors (1.9% ± 1.5 mmol/L; p < 0.001). The area under the ROC curve for blood lactate was 0.76 ± 0.04 (95 % CI: 0.67-0.85). No statistically significant differences were found between either ROC curves. In survivors, a significant relationship was found between PIM score and length of stay in the PICU while in nonsurvivors an inverse relationship was found between blood lactate concentrations and length of stay.

Conclusions

Both PIM score and blood lactate concentrations on admission to the PICU have a moderate prognostic value in critically-ill children. The prognostic value of the PIM score is greater than that of blood lactate concentration but is more difficult to obtain, whereas blood lactate determinationis fast and easy.

Key words::
Prognosis
Severity
Mortality
Pediatric intensive care
Critically-ill children
Lactate
Pediatric index of mortality
El Texto completo está disponible en PDF
Bibliografía
[1.]
A.D. Slonim, M.M. Pollack.
Sistemas de valoración en cuidados intensivos pediátricos.
Manual de Cuidados Intensivos Pediátricos, pp. 46-51
[2.]
S. Prieto, A. Medina, A. Concha, C. Rey, S. Menéndez, M. Crespo.
Asistencia a los niños críticamente enfermos en Asturias: características y efectividad.
An Esp Pediatr, 57 (2002), pp. 22-28
[3.]
J.P. Marcin, M.M. Pollack.
Review of the methodologies and applications of scoring systems in neonatal and pediatric intensive care.
Pediatr Crit Care Med, 1 (2000), pp. 20-27
[4.]
T.S. Yeh, M.M. Pollack, U.E. Ruttimann, P.R. Holbrook, A.L. Fields.
Validation of a physiologic stability index for use in critically ill infants and children.
Pediatr Res, 8 (1984), pp. 445-451
[5.]
W.A. Knaus, D.P. Wagner, E.A. Draper.
The Apache III Prognostic System Risk Prediction of Hospital Mortality for Critically Ill Hospitalized Adults.
Chest, 100 (1991), pp. 1619-1636
[6.]
D.K. Richardson, J.E. Gray, M.C. Mc Cormick.
Score for neonatal acute physiology: A physiologic severity index for neonatal intensive care.
Pediatrics, 91 (1993), pp. 617-623
[7.]
M.M. Pollack, U.E. Ruttimann, P.R. Gerson.
Pediatric risk of mortality (PRISM) score.
Crit Care Med, 16 (1988), pp. 1110-1116
[8.]
M.M. Pollack, K.M. Patel, U.E. Ruttiman.
PRISM III:An updapted pediatric risk of mortality score.
Crit Care Med, 24 (1996), pp. 743-752
[9.]
S. Leteurte, F. Leclerc, A. Martinot, R. Cremer, C. Fourier, A. Sadik, et al.
Can generic scores (Pediatric Risk of Mortality and Pediatric Index of Mortality) replace specific scores in predicting the outcome of presumed meningococcal septic shock in childrenα.
Crit Care Med, 29 (2001), pp. 1239-1246
[10.]
A. Castellanos-Ortega, M. Delgado Rodriguez, J. Llorca, P. Sanchez Buron, S. Mencia Bartolome, A. Soult Rubio, et al.
A new prognostic scoring system for meningococcal septic shock in children. Comparison with three other scoring systems.
Intensive Care Med, 28 (2002), pp. 341-351
[11.]
J. López-Herce, M.A. Delgado, R. Madero, P. Dorao, P. Elola, F. Ruza.
Utilidad pronóstica de cinco índices de gravedad en el paciente pediátrico críticamente enfermo.
An C Intensivos, 5 (1990), pp. 94-98
[12.]
J.D. Wilkinson, M.M. Pollack, U.E. Ruttiman.
Outcome of pediatric patients with multiple organ system failure.
Crit Care Med, 14 (1986), pp. 271-274
[13.]
A.R. Keene, D.J. Cullen.
Therapeutic intervention scoring system: Update 1983.
Crit Care Med, 11 (1983), pp. 1-3
[14.]
R.J. Gemke, J. Van Vught.
Scoring systems in pediatric intensive care: PRISM III versus PIM.
Intensive Care Med, 28 (2002), pp. 204-207
[15.]
F. Shann, G. Pearson, A. Slater, K. Wilkinson.
Paediatric index of mortality (PIM): A mortality prediction model for children in intensive care.
Intensive Care Med, 23 (1997), pp. 201-207
[16.]
M. Haterill, A.G. McIntyre, M. Wattie, I.A. Murdoch.
Early hyperlactataemia in critically ill children.
Intensive Care Med, 26 (2000), pp. 314-318
[17.]
A.G. Randolph.
Paediatric index of mortality (PIM): Do we need another paediatric mortality prediction scoreα.
Intensive Care Med, 23 (1997), pp. 141-142
[18.]
G.D. Jones, K. Thorburn, A. Tigg, I.A. Murdoch.
Preliminary data: PIM vs PRISM in infants and children post cardiac surgery ina a UK PICU.
Intensive Care Med, 26 (2000), pp. 145
[19.]
G. Marecaux, M.R. Pinsky, E. Dupont, R.J. Kahn, J.L. Vincent.
Blood lactate levels are better prognostic indicators than TNF and IL-6 levels in patients with septic shock.
Intensive Care Med, 22 (1996), pp. 404-408
[20.]
B. Kaufman.
Blood lactate measurement in the ICU: Is it still useful after all these yearsα.
J Intensive Care Med, 13 (1998), pp. 215-217
[21.]
C. Singarajah, R.W. Carlson.
A review of the role of blood lactate measurements in the ICU.
J Intensive Care Med, 13 (1998), pp. 218-228
[22.]
R.J. Henning, M.H. Weil, F. Weiner.
Blood lactate as a prognostic indicator of survival in patients with acute myocardial infarction.
Circ Shock, 9 (1982), pp. 307-315
[23.]
J. Aduen, W. Bernstein, T. Khastgir, J. Miller, R. Kerzner, A. Bhatiani, et al.
The use and clinical importance of a substrate-specific electrode for rapid determination of blood lactate concentrations.
JAMA, 272 (1994), pp. 1678-1685
[24.]
A. Sauaia, F. Moore, E. Moore.
Early predictors of postinjury multiple organ failure.
Arch Surg, 129 (1994), pp. 39-45
[25.]
A.J. Drummond, G.R. Bernard, J.A. Russell.
Decreasing lactate is associated with lower mortality in patients who have sepsis syndrome.
Chest, (1993), pp. 104-157
[26.]
J. McNellis, C.P. Marini, A. Jurkiewicz, S. Szomstein, H.H. Simms, G. Ritter, et al.
Prolonged lactate clearance is associated with increased mortality in the surgical intensive care unit.
Am J Surg, 182 (2001), pp. 481-485
[27.]
M. Hatherill, T. Sajjanhar, S.M. Tibby, M.P. Champion, D. Anderson, M.J. Marsh, et al.
Serum lactate as a predictor of mortality after paediatric cardiac surgery.
Arch Dis Child, 77 (1997), pp. 235-238
[28.]
S. Shemie.
Serum lactate predicts postoperative complications after pediatric cardiac surgery.
Pediatr Res, 39 (1996), pp. 54-307
[29.]
N. Shime, K. Kaageyama, H. Ashida, M. Ueda, Y. Kitamura, Y. Tanaka.
Perioperative assessment of blood lactate levels in pediatric haerat surgery.
Masui, 50 (2001), pp. 752-757
[30.]
S.A. Deshpande, M.P. Platt.
Association between blood lactate and acid-base status and mortality in ventilated babies.
Arch Dis Child Fetal Neonatal, 76 (1997), pp. 15-20
[31.]
J.A. Hanley, B.J. McNeil.
A method of comparing the areas under receiver operating characteristic curves derived from the same cases.
Radiology, 148 (1983), pp. 839-843
[32.]
G.A. Pearson, J. Stickley, F. Shann.
Calibration of the pediatric index of mortality in UK paediatric intensive care units.
Arch Dis Child, 84 (2001), pp. 125-128
[33.]
J. Bakker, M. Coffernils, M. Leon.
Blood lactate levels are superior to oxygen derived variables in predicting outcome in human septic shock.
Circ Shock, 9 (1982), pp. 307-315
[34.]
G. Bernardin, C. Pradier, F. Tiger, P. Deloffre, M. Mattei.
Blood pressure and arterial lactate level are early indicators of short-term survival in human septic shock.
Intensive Care Med, 22 (1996), pp. 17-25
[35.]
B.A. Mizock.
Significance of hyperlactatemia without acidosis during hypermetabolic stress.
Crit Care Med, 25 (1997), pp. 1780-1781
[36.]
P.W. Stacpoole.
Lactic acidosis. Endocrinology and metabolism.
Clin North Am, 22 (1993), pp. 221-245
[37.]
E.V. Jackson, J. Wiese, B. Sigal, J. Miller, W. Bernstein, D. Kassel, et al.
Effects of crystaloid solutions on circulating lactate concentrations: Part 1. Implications for proper handling of blood specimens obtained from critically ill patients.
Crit Care Med, 25 (1997), pp. 1840-1846
[38.]
M.A. Dugas, F. Proulx, A. De Jaeger, J. Lacroix, M. Lambert.
Markers of tissue hypoperfusion in pediatric septic shock.
Intensive Care Med, 26 (2000), pp. 75-83
[39.]
J. Wiese, A. Didwania, R. Kerzner, B. Chernow.
Use of different anticoagulants in test tubes for analysis of blood lactate concentrations: Part 2 Implications for the proper handling of blood specimens obtained from critically ill patients.
Crit Care Med, 25 (1997), pp. 1847-1850
Copyright © 2002. Asociación Española de Pediatría
Idiomas
Anales de Pediatría
Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?