摘要
目的通过分析脓毒性休克患者短期预后发生的相关影响因素,建立并评估个体化预测脓毒性休克患者短期预后发生风险的列线图模型。方法选取2017年6月—2020年7月上海交通大学附属第六人民医院南院ICU诊治的脓毒性休克患者150例作为研究对象,并依据患者7 d转归情况分为死亡组(46例)和存活组(104例)。收集患者基本信息和临床资料,采用Logistic回归模型分析脓毒性休克患者短期预后不良发生的独立危险因素,应用列线图在线网站绘制预测脓毒性休克患者短期预后发生风险的列线图模型,采用受试者工作特征曲线(ROC)、校准曲线及Hosmer-Lemeshow拟合优度检验评估列线图模型进行验证。结果与存活组比较,死亡组降钙素原(PCT)、入ICU时急性生理与慢性健康评分(APACHEⅡ评分)、1-磷酸鞘氨醇(S1P)、C反应蛋白(CRP)、中性粒细胞与淋巴细胞比值(NLR)水平均升高(t/P=2.965/0.004、3.806/0.000、3.492/0.001、3.123/0.002、2.448/0.016)。Logistic回归模型显示,高PCT、APACHEⅡ评分、S1P、CRP及NLR水平是脓毒性休克患者短期预后不良发生的独立危险因素[OR(95%CI)=1.093(1.026~1.163)、1.590(1.210~2.089)、1.394(1.062~1.829)、1.076(1.011~1.144)、1.116(1.029~1.209)]。ROC结果显示,列线图模型预测脓毒性休克患者短期预后不良发生风险的AUC为0.890。校准曲线为斜率接近为1的直线,Hosmer-Lemeshow拟合优度检验χ^(2)=13.079,P=0.109。结论基于PCT、APACHEⅡ评分、S1P、CRP及NLR水平分析脓毒性休克患者短期预后不良发生的独立影响因素,并构建预测脓毒性休克患者短期预后不良发生风险的列线图模型,具有良好的区分度与准确度。
Objective To establish and evaluate a nomogram model for predicting the risk of short-term prognosis of patients with septic shock by analyzing the related factors of short-term prognosis in patients with septic shock.Methods From June 2017 to July 2020,150 patients with septic shock diagnosed and treated in the ICU,South Hospital of the Sixth People's Hospital Affiliated to Shanghai Jiaotong University were selected as the research objects,and the subjects were divided into death group(46 cases)and survival group(104 cases)according to the 7-day outcome of patients.Basic information and clinical data of patients were collected.Logistic regression model was used to analyze the independent risk factors of short-term poor prognosis in patients with septic shock.A nomogram model was developed to predict the risk of short-term prognosis in patients with septic shock.Receiver operating characteristic curve(ROC),calibration curve and Hosmer-Lemeshow goodness-of-fit test were used to evaluate and verified the nomogram model.Results Procalcitonin(PCT),acute physiology and chronic health evaluation score(APACHEⅡscore)at ICU admission,sphingosine 1-phosphate(S1P),C-reactive protein(CRP)and neutrophil to lymphocyte ratio(NLR)levels in death group were higher than those in survival group(t/P=2.965/0.004,3.806/0.000,3.492/0.001,3.123/0.002,2.448/0.016).Logistic regression model showed that PCT,APACHEⅡscore,S1P,CRP and NLR levels were independent risk factors of short-term adverse prognosis in patients with septic shock[OR(95%CI)=1.093(1.026-1.163),1.590(1.210-2.089),1.394(1.062-1.829),1.076(1.011-1.144),1.116(1.029-1.209)].ROC results showed that the AUC of predicting the risk of poor short-term prognosis in patients with septic shock was 0.890.The calibration curve was a straight line with slope close to 1.Hosmer-Lemeshow goodness-of-fit test showedχ^(2)=13.079,P=0.109.Conclusion Based on PCT,APACHEⅡscore,S1P,CRP and NLR levels,the independent influencing factors of poor short-term prognosis in patients with septic shock were analyzed,and the nomogram model for predicting the risk of short-term poor prognosis in patients with septic shock has good discrimination and accuracy.
作者
郑从波
胡芳宝
王文
窦红杰
林凌
王德强
Zheng Congbo;Hu Fangbao;Wang Wen;Dou Hongjie;Lin Ling;Wang Deqiang(ICU, South Hospital of the Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 201400,China)
出处
《疑难病杂志》
CAS
2021年第5期488-491,496,共5页
Chinese Journal of Difficult and Complicated Cases
基金
上海市科学技术委员会科研计划项目(18401321104)。
关键词
脓毒性休克
短期预后
预测模型
列线图
构建
评估
Septic shock
Short-term prognosis
Predictive model
Nomogram
Construction
Evaluation
