Data_Sheet_1_Evaluation of the neonatal sequential organ failure assessment and mortality risk in neonates with respiratory distress syndrome: A retrospective cohort study.DOCX

BackgroundRespiratory distress syndrome (RDS) is one of the leading causes of neonatal death in the neonatal intensive care unit (NICU). Previous studies have suggested that the development of neonatal RDS may be associated with inflammation and lead to organ dysfunction. The neonatal sequential organ failure assessment (nSOFA) scoring system is an operational definition of organ dysfunction, but whether it can be used to predict mortality in neonates RDS is unknown. The aim of this study was to clarify the performance of the nSOFA score in predicting mortality in patients with neonatal RDS, with the aim of broadening the clinical application of the nSOFA score.
MethodsNeonates with RDS were identified from the Medical Information Mart for Intensive Care (MIMIC)-III database. Cox proportional hazards model were used to assess the association between nSOFA score and mortality. Propensity score matched analysis were used to assess the robustness of the analytical results.
ResultsIn this study of 1,281 patients with RDS of which 57.2% were male, death occurred in 40 cases (3.1%). Patients with high nSOFA scores had a higher mortality rate of 10.7% compared with low nSOFA scores at 0.3%. After adjusting for confounding, multivariate Cox proportional risk analysis showed that an increase in nSOFA score was significantly associated with increased mortality in patients with RDS [adjusted Hazards Ratio (aHR): 1.48, 95% Confidence Interval (CI): 1.32–1.67; p < 0.001]. Similarly, the High nSOFA group was significantly associated with higher mortality in RDS patients (aHR: 19.35, 95% CI: 4.41–84.95; p < 0.001) compared with the low nSOFA group.
ConclusionThe nSOFA score was positively associated with the risk of mortality in cases of neonatal RDS in the NICU, where its use may help clinicians to quickly and accurately identify high risk neonates and implement more aggressive intervention.

背景：呼吸窘迫综合征（Respiratory Distress Syndrome, RDS）是新生儿重症监护病房（Neonatal Intensive Care Unit, NICU）内新生儿死亡的主要诱因之一。既往研究表明，新生儿呼吸窘迫综合征的发生可能与炎症反应相关，并可引发器官功能障碍。新生儿序贯器官衰竭评分（neonatal Sequential Organ Failure Assessment, nSOFA）系统是评估器官功能障碍的标准化定义，但其能否用于预测新生儿呼吸窘迫综合征患者的病死率尚未明确。本研究旨在明确新生儿序贯器官衰竭评分在预测新生儿呼吸窘迫综合征患者病死率中的应用价值，以期拓展该评分系统的临床应用场景。
方法：从重症监护医学信息数据库（Medical Information Mart for Intensive Care, MIMIC-III）中筛选确诊为呼吸窘迫综合征的新生儿。采用Cox比例风险模型评估新生儿序贯器官衰竭评分与病死率之间的关联；通过倾向得分匹配分析验证研究结果的稳健性。
结果：本研究共纳入1281例呼吸窘迫综合征新生儿，其中57.2%为男性，共计40例患者死亡，病死率为3.1%。新生儿序贯器官衰竭评分较高的组病死率达10.7%，而评分较低的组病死率仅为0.3%。校正混杂因素后的多因素Cox比例风险分析显示，新生儿序贯器官衰竭评分升高与呼吸窘迫综合征新生儿的病死率升高显著相关[校正后风险比（adjusted Hazards Ratio, aHR）=1.48，95%置信区间（Confidence Interval, CI）：1.32~1.67；P<0.001]。相较于评分较低的组，高评分组呼吸窘迫综合征新生儿的病死率同样显著升高（校正后风险比=19.35，95%置信区间：4.41~84.95；P<0.001）。
结论：新生儿重症监护病房内的新生儿呼吸窘迫综合征患者中，新生儿序贯器官衰竭评分与死亡风险呈正相关，临床应用该评分可帮助医护人员快速、准确地识别高危新生儿，并采取更为积极的干预措施。