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Received:November 14, 2023 Published Online:November 20, 2024
Received:November 14, 2023 Published Online:November 20, 2024
中文摘要: 目的 构建脓毒症死亡风险预测模型,以期为提高脓毒症患者死亡风险预警、改善脓毒症患者结局提供参考。方法 回顾性收集2019年1月至2022年5月华中科技大学同济医学院附属同济医院综合ICU收治的符合诊断标准的脓毒症患者286例的资料,采用t检验、χ2检验和Mann-WhitneyU检验对脓毒症患者的死亡风险进行单因素分析,进一步进行多因素分析,并构建脓毒症死亡风险预测模型。结果 统计患者入住ICU后28 d存活情况,286例脓毒症患者,生存165例(57.69%),死亡121例(42.31%)。初始感染部位为肺部、腹腔、皮肤软组织和泌尿系统,诊断为脓毒症距入院时间、首次集束化治疗距发病时间、年龄、入住ICU时的乳酸值和APACHE Ⅱ评分、发生低体温、行连续性肾脏替代疗法(CRRT)治疗、首发症状有发热、ICU住院天数,以及入住ICU时肌酐、降钙素原、纤维蛋白原水平是脓毒症患者死亡的独立影响因素(P<0.05)。脓毒症患者死亡风险预测模型的ROC曲线下面积(AUC)为0.970,敏感度为0.893,特异度为0.933,最大约登指数为0.826。结论 对脓毒症患者死亡风险预防还需关口前移,重视患者院前死亡风险因素,把握确诊性治疗前的病情变化,以减少和避免不良结局。本研究初步构建的脓毒症患者死亡风险预测模型具有较好的预测能力,能够为临床工作提供一定的参考价值。
Abstract:b>Objective To construct a death risk prediction model of sepsis, in order to provide reference for improving the early warning of death risk and improving the outcome of sepsis patients. Methods The data of 286 sepsis patients who met the diagnostic criteria in the comprehensive ICU of Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology from January 2019 to May 2022 were retrospectively collected. The t test, chi-square test and Mann-Whitney Utest were used to conduct univariate analysis on the death risk of sepsis patients, and then multivariate analysis was carried out, and a prediction model of sepsis death risk was established. Results The survival status of 28 days after admission to ICU was calculated. Of 286 patients with sepsis, 165 (57.69%) survived and 121 (42.31%) died. The initial infection sites were lung, abdominal cavity, skin and soft tissue, urinary system, the time between diagnosis of sepsis and admission, time from onset to first cluster therapy, age, lactic acid level and APACHEⅡ score at admission to ICU, occurrence of hypothermia, continuous renal replacement therapy (CRRT), first symptoms of fever at onset, length of stay in ICU, the levels of creatinine, procalcitonin and fibrinogen at ICU admission were independent influencing factors of death in sepsis patients (P<0.05). The area under the ROC curve of the death risk prediction model for sepsis patients was 0.970, with a sensitivity of 0.893, a specificity of 0.933, and a maximum Youden index of 0.826. Conclusion The prevention focus of death risk in sepsis patients needs to be moved forward, the risk factors of pre-hospital death of patients should be paied attention to, the changes in the condition before confirmatory treatment should be grasped, in order to reduce and avoid adverse outcomes. In addition, the preliminarily constructed death risk prediction model for sepsis patients in this study has good predictive ability, and can provide certain reference value in clinical work.
keywords: Sepsis Death Risk prediction model Continuous renal replacement therapy Procalcitonin Fibrinogen
文章编号: 中图分类号:R631 文献标志码:A
基金项目:华中科技大学同济医学院附属同济医院中青年科研基金项目(2021HL007)
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