行机械通气脓毒症患者28天死亡风险预测模型构建  

Construction of 28-day Mortality Risk Prediction Model for Patients with Sepsis Undergoing Mechanical Ventilation

作　　者：蒋忠洋[1] 莫军 孙欢[1] 刘渝鹏 Jiang Zhongyang;Mo Jun;Sun Huan(Critical Care Department,Mianyang Central Hospital,Mianyang,Sichuan 621000,China.)

机构地区：[1]绵阳市中心医院重症医学科,四川绵阳621000

出　　处：《四川医学》2023年第3期262-267,共6页Sichuan Medical Journal

摘　　要：目的 探究影响行机械通气脓毒症患者28 d死亡的危险因素并构建风险预测模型。方法 选择2019年2月至2021年2月我院收治的102例行机械通气的脓毒症患者作为研究对象,根据随访28 d患者的生存情况,分为存活组(61例)和死亡组(41例)。比较两组患者的一般资料和实验室检查指标,多因素Logistic回归分析影响患者28 d死亡的因素,构建风险评分模型并评价其预测效能。结果 死亡组血管活性药物应用患者比例、APACHEⅡ评分、血清SCr水平明显高于存活组,PLT、FT_(4)、T_(3)、T_(4)水平明显低于存活组(P<0.05);血管活性药物应用、APACHEⅡ评分增加、PLT、FT_(4)、T_(3)、T_(4)水平下降、SCr水平升高是导致行机械通气脓毒症患者28 d死亡的危险因素(P<0.05);将上述危险因素纳入风险评分模型,分别赋予36、49、25、27、33、45、38分的权重,将总分≤72分定义为中危组,>72分且≤185分定义为高危组,>185分定义为极高危组;风险评分模型的ROC曲线下面积、灵敏度、特异度分别为0.876(95%CI 0.843~0.909,P<0.001)、93.42%、87.45%,区分度较好,校准曲线及生存曲线提示模型预测的准确性较好。结论 分析影响行机械通气脓毒症患者28 d死亡的危险因素并构建风险评分模型,有利于临床上早期识别高危人群,指导医护人员采取个体化的治疗和护理方案,对降低患者死亡率有重要意义。Objective To explore risk factors that affect the 28-day death of patients with sepsis on mechanical ventilation and construct a risk prediction model.Methods From February 2019 to February 2021,102 mechanically ventilated sepsis patients admitted to our hospital were selected as research subjects.According to survival status of patients during 28-day follow-up,they were divided into survival group(n=61)and death group(n=41).General data and laboratory test indicators were compared.Multivariate logistic regression analysis of factors affecting death of patients at 28 days and a risk scoring model were constructed and its predictive power was evaluated.Results The proportion of patients using vasoactive drugs in death group,APACHEⅡscore,and serum SCr were significantly higher than those in survival group,and PLT,FT_(4),T_(3),and T_(4) were significantly lower than those in survival group(P<0.05).Vasoactive drug applications,increased APACHEⅡscore,decreased PLT,FT4,T3 and T4,and increased SCr were risk factors leading to 28-day death in patients with sepsis on mechanical ventilation(P<0.05).Incorporate the above risk factors into the risk scoring model,and assign weights of 36,49,25,27,33,45,and 38 points,respectively.Total score≤72 points was defined as intermediate risk group,and total score≤72 points was defined as high risk group.Group>185 points was defined as extremely high-risk group.The area under ROC curve,sensitivity,and specificity of risk scoring model were 0.876(95%CI 0.843~0.909,P<0.001),93.42%,and 87.45%,respectively,showing good discrimination,calibration curve and survival curve indicate that accuracy of the model prediction was better.Conclusion Analyzing risk factors that affect the 28-day death of patients with sepsis on mechanical ventilation and constructing a risk scoring model is conducive to early identification of high-risk groups in clinical practice,guiding medical staff to adopt individualized treatment and nursing plans,and is of great significance to reducing patient mortality

关 键 词：机械通气 脓毒症 死亡 危险因素 风险评分模型 

分 类 号：R631.2[医药卫生—外科学]