年龄校正Charlson合并症指数评估基础疾病对脓毒症患者院内死亡风险的影响  

Age-adjusted Charlson comorbidity index in assessing the risk of mortality in hospitalized patients with sepsis

作　　者：叶渊文 潘琴 李飞飞 陈玲珑[1] YE Yuanwen;PAN Qin;LI Feifei;CHEN Linglong(Department of Emergency,the Third Clinical Institute Affiliated to Wenzhou Medical University,Wenzhou People's Hospital,Wenzhou 325000,China;不详)

机构地区：[1]温州医科大学第三临床学院、温州市人民医院急诊医学科,325000 [2]温州医科大学第三临床学院、温州市人民医院麻醉手术室,325000

出　　处：《浙江医学》2022年第16期1773-1776,共4页Zhejiang Medical Journal

摘　　要：目的 探讨年龄校正Charlson合并症指数(ACCI)评估基础疾病对脓毒症患者院内死亡风险的影响。方法 提取美国重症监护医学信息数据库-IV(MIMIC-IV)中脓毒症患者的基本信息和临床资料,根据院内死亡事件将患者分为生存组和死亡组,采用1∶1倾向性评分匹配校正基线资料包括性别、年龄及序贯器官衰竭评分(SOFA)后比较组间ACCI差异。采用ROC曲线确定最佳截断值,采用logistic回归模型分析ACCI与院内死亡风险的相关性。结果 MIMIC-IV数据库共计35 010例脓毒症患者,1∶1倾向性评分匹配后3 828对患者纳入本次研究。与生存组相比,死亡组患者ACCI分值更高,差异有统计学意义(P<0.01)。随着ACCI分值增加,患者死亡风险逐渐增加。ACCI最佳截断值为7.5分,logistic回归模型分析显示ACCI分值升高是脓毒症患者院内死亡风险的危险因素(OR=1.524,95%CI:1.389~1.672,P<0.01)。结论 脓毒症患者基础疾病会影响疾病预后,且ACCI分值越大,院内死亡风险越高。Objective To evaluate the application of age-adjusted Charlson comorbidity index in assessing the risk of mortality in hospitalized patients with sepsis. Methods Basic information and clinical data were extracted from Medical Information Mart for Intensive Care Database-IV(MIMIC-IV), and the patients were divided into survival group and death group. Using 1:1 propensity score matching(PSM) to calibrate baseline data including sex, age and sequential organ failure score(SOFA), the intergroup differences were compared. Receiver Operating Characteristic curve(ROC) was used to determine the optimal cut-off value. Logistic regression model was used to analyze the risk of in-hospital mortality. Results A total of 35 010 cases of sepsis patients were included in the database, and 3 828 patients were enrolled after 1:1 PSM.Compared with the survival group, ACCI in the death group were significantly higher(P<0.01). The risk of in-hospital mortality increased with the increasing of ACCI score. The best cut-off value for ACCI was 7.5, and logistic regression analysis showed that elevated ACCI was an independent risk factor for in-hospital mortality in septic patients(OR=1.524,95%CI:1.389-1.672,P<0.01).Conclusion The underlying disease will affect the prognosis of patients with sepsis, patients with higher ACCI score will have higher the risk of in-hospital mortality.

关 键 词：Charlson合并症指数 脓毒症 预后 

分 类 号：R459.7[医药卫生—急诊医学]