Clinical study of prognosis factors for children with dyspnea in emergency department

doi:10.3877/cma.j.issn.1673-5250.2016.02.003

Objective

To identify the prognosis factors for children with dyspnea in emergency department.

Methods

From October 2013 to October 2015, a total of 364 cases of children with dyspnea whose medical records were complete in Department of Emergency, West China Second University Hospital, Sichuan University were selected as research subjects. Among them, 230 (63.2%) cases were boys and 134 (36.8%) cases were girls. The age was 1 month to 13 years old and the median age was 7 months old. According to pediatric risk of mortality (PRISM) Ⅲ score, relevant references and biochemical indicators detected in emergency department, age, gender, received mechanical ventilation or not, combined with congenital disease or not, admitted to pediatric intensive care unit (PICU) or not, heart rate, level of hemoglobin, hematocrit, serum Ca²⁺ concentration, level of plasma albumin, arterial pH value, hemoglobin oxygen saturation by pulse oximetry (SpO₂), arterial oxygen saturation (SaO₂), partial pressure of carbon dioxide (PaCO₂), partial pressure of oxygen (PaO₂), level of blood lactate and base excess were selected as possible prognosis factors for children with dyspnea in emergency department. Retrospective method was used to analyze the clinical data, those 17 possible prognosis factors and the main diagnosis and prognosis were recorded. The rates of unfavourable prognosis of each possible prognosis factors were compared by chi-square test. According to the significant positive factors in chi-square test, and considering the other research results and professional knowledge, 8 factors were further processed as independent variables when the prognosis set as dependent variable in a multivariate unconditional logistic regression model. The study protocol was approved by the Ethical Review Board of Investigation in West China Second University Hospital, Sichuan University.

Results

①The rates of unfavourable prognosis of mechanical ventilation, admitted to PICU, combined with congenital disease, abnormal serum Ca²⁺ concentration, SpO₂, PaO₂ and base excess (38.4%, 30.8%, 30.8%, 23.7%, 34.7%, 31.7%, 23.3%) were higher than those without mechanical ventilation, didn't admitted to PICU, without congenital disease, with normal serum Ca²⁺ concentration, SpO₂, PaO₂ and base excess (13.1%, 11.9%, 11.9%, 12.1%, 15.6%, 16.4%, 13.9%), respectively, and all the differences were statistically significant (χ²=25.161, 19.456, 19.456, 8.255, 10.463, 5.736, 5.338; P<0.05). The rates of unfavourable prognosis between different ages, gender, heart rate, level of hemoglobin, hematocrit, level of plasma albumin, arterial pH value, SaO₂, PaCO₂ and level of blood lactate, there were no statistical significances (P>0.05). ②According to the multivariate logistic regression analysis result, mechanical ventilation, admitted to PICU, congenital disease, abnormal serum Ca²⁺ concentration and SpO₂ were independent risk factors for prognosis of children with dyspnea in emergency department (OR=2.521, 2.260, 3.867, 1.992, 2.225; 95% CI: 1.244-5.109, 1.112-4.594, 2.122-7.045, 1.068-3.719, 1.059-4.677; P=0.010, 0.024, 0.000, 0.030, 0.035).

Conclusions

As to children with dyspnea in emergency department, emergency physicians should pay much attention to independent risk factors of their prognosis, such as mechanical ventilation, admitted to PICU, congenital disease, serum Ca²⁺ concentration and SpO₂ which may play an active role on treating children with dyspnea in emergency department.

Key words: Emergency department, Dyspnea, Child, Prognosis, Logistic models

表1 本研究观察的17个不同影响因素对急诊科呼吸困难患儿预后不良发生率比较[例数(%)]

影响因素		例数	预后不良发生率	χ²值	P值
性别				0.007	0.933
	男	230	42(18.3)
	女	134	24(17.9)
年龄(岁)				0.031	0.861
	≤1	246	44(17.9)
	>1	118	22(18.6)
是否进行有创通气				25.161	<0.001
	是	73	28(38.4)
	否	291	38(13.1)
是否入住PICU				19.456	<0.001
	是	120	37(30.8)
	否	244	29(11.9)
是否合并先天性疾病				19.456	<0.001
	是	120	37(30.8)
	否	244	29(11.9)
心率				3.509	0.061
	正常	285	46(16.1)
	异常	79	20(25.3)
动脉血pH值				0.023	0.879
	正常	201	37(18.4)
	异常	163	29(17.8)
血红蛋白水平				1.762	0.184
	正常	214	34(15.9)
	异常	150	32(21.3)
血细胞比容				0.354	0.552
	正常	243	42(17.3)
	异常	121	24(19.8)
血Ca^2＋水平				8.255	0.004
	正常	174	21(12.1)
	异常	190	45(23.7)
血清白蛋白水平				0.522	0.470
	正常	240	41(17.1)
	异常	124	25(20.2)
SpO₂				10.463	<0.001
	正常	315	49(15.6)
	异常	49	17(34.7)
SaO₂				3.470	0.062
	正常	313	52(16.6)
	异常	51	14(27.5)
PaO₂				5.736	0.017
	正常	323	53(16.4)
	异常	41	13(31.7)
PaCO₂				0.038	0.848
	正常	317	57(18.0)
	异常	47	9(19.1)
血乳酸水平				3.464	0.063
	正常	124	16(12.9)
	异常	240	50(20.8)
剩余碱水平				5.338	0.021
	正常	201	28(13.9)
	异常	163	38(23.3)

表1 本研究观察的17个不同影响因素对急诊科呼吸困难患儿预后不良发生率比较[例数(%)]

影响因素		例数	预后不良发生率	χ²值	P值
性别				0.007	0.933
	男	230	42(18.3)
	女	134	24(17.9)
年龄(岁)				0.031	0.861
	≤1	246	44(17.9)
	>1	118	22(18.6)
是否进行有创通气				25.161	<0.001
	是	73	28(38.4)
	否	291	38(13.1)
是否入住PICU				19.456	<0.001
	是	120	37(30.8)
	否	244	29(11.9)
是否合并先天性疾病				19.456	<0.001
	是	120	37(30.8)
	否	244	29(11.9)
心率				3.509	0.061
	正常	285	46(16.1)
	异常	79	20(25.3)
动脉血pH值				0.023	0.879
	正常	201	37(18.4)
	异常	163	29(17.8)
血红蛋白水平				1.762	0.184
	正常	214	34(15.9)
	异常	150	32(21.3)
血细胞比容				0.354	0.552
	正常	243	42(17.3)
	异常	121	24(19.8)
血Ca^2＋水平				8.255	0.004
	正常	174	21(12.1)
	异常	190	45(23.7)
血清白蛋白水平				0.522	0.470
	正常	240	41(17.1)
	异常	124	25(20.2)
SpO₂				10.463	<0.001
	正常	315	49(15.6)
	异常	49	17(34.7)
SaO₂				3.470	0.062
	正常	313	52(16.6)
	异常	51	14(27.5)
PaO₂				5.736	0.017
	正常	323	53(16.4)
	异常	41	13(31.7)
PaCO₂				0.038	0.848
	正常	317	57(18.0)
	异常	47	9(19.1)
血乳酸水平				3.464	0.063
	正常	124	16(12.9)
	异常	240	50(20.8)
剩余碱水平				5.338	0.021
	正常	201	28(13.9)
	异常	163	38(23.3)

表2 急诊科呼吸困难患儿预后非条件多因素logistic回归分析赋值表

应变量/自变量	变量名	赋值
预后	Y	Y＝1，表示患儿预后不良(放弃、未愈或死亡)；Y＝0，表示患儿预后良好(好转或治愈)
进行有创通气	X1	X1＝1，表示患儿进行有创通气；X1＝0，表示患儿未进行有创通气
入住PICU	X2	X2＝1，表示患儿入住PICU; X2＝0，表示患儿未入住PICU
合并先天性疾病	X3	X3＝1，表示患儿合并先天性疾病；X3＝0，表示患儿未合并先天性疾病
血Ca^2＋水平	X4	X4＝1，表示患儿血Ca^2＋水平异常；X4＝0，表示患儿血Ca^2＋水平正常
SpO₂	X5	X5＝1，表示患儿SpO₂异常，X5＝0，表示患儿SpO₂正常
PaO₂	X6	X6＝1，表示患儿PaO₂异常，X6＝0，表示患儿PaO₂正常
血乳酸水平	X7	X7＝1，表示患儿血乳酸水平异常；X7＝0，表示患儿血乳酸水平正常
剩余碱水平	X8	X8＝1，表示患儿剩余碱水平异常；X8＝0，表示患儿剩余碱水平正常

表2 急诊科呼吸困难患儿预后非条件多因素logistic回归分析赋值表

应变量/自变量	变量名	赋值
预后	Y	Y＝1，表示患儿预后不良(放弃、未愈或死亡)；Y＝0，表示患儿预后良好(好转或治愈)
进行有创通气	X1	X1＝1，表示患儿进行有创通气；X1＝0，表示患儿未进行有创通气
入住PICU	X2	X2＝1，表示患儿入住PICU; X2＝0，表示患儿未入住PICU
合并先天性疾病	X3	X3＝1，表示患儿合并先天性疾病；X3＝0，表示患儿未合并先天性疾病
血Ca^2＋水平	X4	X4＝1，表示患儿血Ca^2＋水平异常；X4＝0，表示患儿血Ca^2＋水平正常
SpO₂	X5	X5＝1，表示患儿SpO₂异常，X5＝0，表示患儿SpO₂正常
PaO₂	X6	X6＝1，表示患儿PaO₂异常，X6＝0，表示患儿PaO₂正常
血乳酸水平	X7	X7＝1，表示患儿血乳酸水平异常；X7＝0，表示患儿血乳酸水平正常
剩余碱水平	X8	X8＝1，表示患儿剩余碱水平异常；X8＝0，表示患儿剩余碱水平正常

表3 急诊科呼吸困难患儿预后非条件多因素logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95% CI
常数项	－3.351	0.385	75.860	0.000
进行有创通气	0.924	0.360	6.578	0.010	2.521	1.244～5.109
入住PICU	0.815	0.362	5.072	0.024	2.260	1.112～4.594
合并先天性疾病	1.352	0.306	19.527	0.000	3.867	2.122～7.045
血Ca^2＋水平	0.689	0.318	4.689	0.030	1.992	1.068～3.719
SpO₂	0.800	0.379	4.454	0.035	2.225	1.059～4.677

表3 急诊科呼吸困难患儿预后非条件多因素logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95% CI
常数项	－3.351	0.385	75.860	0.000
进行有创通气	0.924	0.360	6.578	0.010	2.521	1.244～5.109
入住PICU	0.815	0.362	5.072	0.024	2.260	1.112～4.594
合并先天性疾病	1.352	0.306	19.527	0.000	3.867	2.122～7.045
血Ca^2＋水平	0.689	0.318	4.689	0.030	1.992	1.068～3.719
SpO₂	0.800	0.379	4.454	0.035	2.225	1.059～4.677

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