基于后负荷校正的心功能参数建立脓毒症心肌病患者预后的列线图预测模型  

Establish the nomogram prediction model of septic cardiomyopathy based on the afterload-corrected cardiac performance

作　　者：陶丽丽[1] 魏星[1] 许琪 杨其霖[1] 张振辉[1] 熊旭明[1] 陈伟燕[1] Tao Lili;Wei Xing;Xu Qi;Yang Qilin;Zhang Zhenhui;Xiong Xuming;Chen Weiyan(Department of Critical Care Medicine,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,Guangdong,China)

机构地区：[1]广州医科大学附属第二医院重症医学科,广东广州510260

出　　处：《中华危重病急救医学》2021年第11期1296-1301,共6页Chinese Critical Care Medicine

基　　金：广东省广州市科技计划项目(202102010068)。

摘　　要：目的基于后负荷校正心功能参数(ACP)建立脓毒症心肌病(SCM)患者预后的列线图预测模型,以早期识别预后不良患者,积极寻找治疗方法。方法回顾性分析2016年6月至2019年6月入住广州医科大学附属第二医院重症医学科并行脉搏指示连续心排血量监测(PiCCO)>24 h、经计算ACP<80%被诊断为SCM的患者资料。采用单因素Cox回归分析筛查SCM患者30 d死亡风险的预测因子;再采用多因素Cox回归分析建立危险因素与SCM患者30 d死亡风险的预测模型,并通过列线图展示,最后用受试者工作特征曲线(ROC曲线)和一致性指数(C-index)对模型进行区分度及校准度分析。结果共纳入102例SCM患者,30 d病死率为60.8%(62例)。102例SCM患者中,心功能轻度受损(60%≤ACP<80%)57例(占55.9%),30 d病死率为43.9%(25/57);心功能中度受损(40%≤ACP<60%)39例(占38.2%),30 d病死率为79.5%(31/39);心功能重度受损(ACP<40%)6例(占5.9%),30 d病死率达100%(6/6);3组间病死率比较差异具有统计学意义(χ^(2)=24.156,P<0.001)。将单因素Cox回归分析中筛选出的SCM患者30 d死亡潜在危险因素纳入多因素Cox回归分析,结果显示,预测SCM患者30 d死亡的独立危险因素有急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、血管活性药物评分(VIS)、连续性肾脏替代治疗(CRRT)和ACP〔APACHEⅡ:风险比(HR)=1.031,95%可信区间(95%CI)为1.002~1.061,P=0.039;VIS:HR=1.003,95%CI为1.001~0.005,P=0.012;CRRT:HR=2.106,95%CI为1.089~4.072,P=0.027;ACP:HR=0.952,95%CI为0.928~0.977,P<0.001〕。用上述独立危险因素和年龄建立列线图模型,其曲线下面积(AUC)为0.865,95%CI为0.795~0.935,P<0.001;C-index为0.797,95%CI为0.747~0.847,P>0.05。结论基于年龄、APACHEⅡ评分、VIS评分、CRRT和ACP建立的列线图模型对SCM患者30 d生存概率的预测具有一定的临床参考意义,区分度和校准度良好,但仍需进一步验证。Objective To establish a nomogram prediction model for the prognosis of patients with septic cardiomyopathy(SCM)based on afterload-corrected cardiac performance(ACP),in order to identify septic patients with poor outcomes and treatment.Methods The data of patients admitted to the department of critical medicine of the Second Affiliated Hospital of Guangzhou Medical University from June 2016 to June 2019 were analyzed.All patients were monitored by pulse indication continuous cardiac output(PiCCO)monitor more than 24 hours and diagnosed as SCM with ACP less than 80%.The predictors of 30-day death risk of SCM patients were screened by univariate Cox regression analysis.Multivariate Cox regression analysis was used to establish the prediction model for 30-day death risk of SCM patients,which was displayed by the nomogram.Finally,the discrimination and calibration of the model were analyzed by receiver operator characteristic curve(ROC curve)and consistency index(C-index).Results A total of 102 patients with SCM were included and the 30-day mortality was 60.8%(62 cases).Among 102 patients with SCM,57 patients(55.9%)had mild impairment of cardiac function(60%≤ACP<80%),and the 30-day mortality was 43.9%(25/57);39 patients(38.2%)had moderate impairment of cardiac function(40%≤ACP<60%),and the 30-day mortality was 79.5%(31/39);6 patients(5.9%)had severe impairment of cardiac function(ACP<40%),and the 30-day mortality was 100%(6/6).There was significantly difference in mortality among the three groups(χ^(2)=24.156,P<0.001).The potential risk factors for 30-day death of SCM patients screened by univariate Cox regression analysis were included in multivariate Cox regression analysis.The results showed that the independent risk factors for 30-day death of SCM patients were acute physiology and chronic health evaluationⅡ[APACHEⅡ,risk ratio(HR)=1.031,95%confidence interval(95%CI)was 1.002-1.061,P=0.039],vasoactive inotropic score(VIS,HR=1.003,95%CI was 1.001-1.005,P=0.012),continuous renal replacement therapy(CRRT;HR=

关 键 词：脓毒症心肌病 后负荷校正心功能参数 列线图 30 d病死率 

分 类 号：R459.7[医药卫生—急诊医学] R542.2[医药卫生—治疗学]