기계환기치료를 적용 받은 급성 호흡부전 소아 환자에서 Sequential Organ Failure Assessment (SOFA) 점수의 초기 변화와 예후와의 관계
Early Changes in the Sequential Organ Failure Assessment (SOFA) Score as a Prognostic Factor in Acute Respiratory Failure in Children with Mechanical Ventilator Support
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목적:기계환기치료를 시행하는 급성 호흡부전 환아에서 단순 호흡부전보다 다발성 장기부전이 동반되어 사망하는 경우가 많다. 따라서 본 연구에서는 급성 호흡부전 환아에서 입원 당시 측정한 SOFA 점수보다 초기 3일간 변화한 SOFA 점수가 예후를 예측하는데 있어 더 유용한 지표인지 조사하였다. 방법:2008년 1월 1일 부터 2009년 5월 31일까지 17개월 동안 서울아산병원 소아중환자실에 입원하여 급성 호흡부전으로 3일 이상 기계환기치료를 적용 받은 소아 환자를 대상으로 의무 기록을 후향적으로 분석하였다. 결과:입원 당시의 SOFA 점수, PRISM III 점수, PELOD 점수, 초기 3일간의 SOFA 점수 변화 모두 사망률과 유의한 관계를 보였으나 특히 초기 3일간의 SOFA 점수 변화가 사망률과 더 밀접한 유의성을 보여주었다(P<0.05). 초기 3일간의 SOFA 점수가 증가한 군에서는 사망률이 42.9%이고 감소한 군에서는 14.5%로 유의한 상관 관계를 보여주었다. 결론:3일 이상 기계환기치료를 시행한 급성 호흡부전 환아에서 초기 3일간의 SOFA 점수 변화는 입원 당일 측정한 SOFA 점수보다 예후를 평가하는데 있어 효용적인 지표이다.
Abstract
Purpose:In pediatric acute respiratory failure patients requiring mechanical ventilator support, mortality is seldom related to respiratory disease alone, but more generally to multiple organ dysfunction syndrome. The purpose of this study is to evaluate whether early changes in the SOFA score (Δ-SOFA) are more effective for predicting the outcome than a single assessment upon admission for pediatric acute respiratory failure patients requiring mechanical ventilator support. Methods:The medical records of pediatric patients with acute respiratory failure requiring mechanical ventilator support for more than 72 hours in the PICU of the Asan Medical Center Children’s Hospital, Seoul, Korea, between January 2008 and May 2009 were retrospectively reviewed. Results:Early Δ-SOFA showed a significantly stronger correlation with patient mortality compared with the initial SOFA score, PRISM III score and PELOD score (P<0.05). When analyzing the trends in the SOFA score during the first 72 hours, the mortality rate was significantly higher in children with increased and unchanged SOFA scores 72 hours after admission than in children with a decreased SOFA score. (14.5% vs. 42.9%, P<0.05)Conclusion:Regardless of the initial SOFA score, early serial evaluation of the SOFA scores during the first 3 days of PICU admission is a better indicator of the prognosis than a single assessment obtained at admission in acute respiratory failure patients mechanically ventilated for more than 3 days.
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