老年脓毒症患者死亡风险列线图模型构建与验证  

A nomogram model for short-term mortality risk in elderly patients with sepsis

作　　者：夏轶姿[1] 张静[2] 刘琛 翁杰[1] 宋佳泽 田伟华 徐慧[1] XIA Yizi;ZHANG Jing;LIU Chen;WENG Jie;SONG Jiaze;TIAN Weihua;XU Hui(Department of General Practice,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,China;Department of Geriatric Medicine,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325015,China;The Second Clinical Medical College,Wenzhou Medical University,Wenzhou 325035,China)

机构地区：[1]温州医科大学附属第二医院全科医学科,浙江温州325027 [2]温州医科大学附属第一医院老年医学科,浙江温州325015 [3]温州医科大学第二临床医学院,浙江温州325035

出　　处：《温州医科大学学报》2023年第6期465-472,共8页Journal of Wenzhou Medical University

基　　金：国家自然科学基金项目(82100074);温州市基础性科研项目(Y20210840)。

摘　　要：目的:探讨影响老年脓毒症患者30 d内死亡预后的危险因素,构建预测老年脓毒症短期院内死亡风险列线图模型。方法:收集温州医科大学附属第二医院与美国大型多中心重症监护数据库的老年脓毒症患者临床数据,如生命体征、实验室检查及30 d内死亡情况。采用单因素、多因素Logistic回归分析,筛选出30 d内死亡的危险因素,并构建预测老年脓毒症患者30 d内死亡的列线图模型。结果:入院首日最低血氧饱和度降低、平均动脉压最低值降低、心率最大值升高、最低体温降低、呼吸频率最高值升高、血浆白蛋白最低值降低、血胆红素最大值升高、血乳酸最大值升高、血尿素氮最大值升高、机械通气、年龄升高、肝功能不全及转移性恶性肿瘤病史是老年脓毒症患者入院30 d内死亡的危险因素,采用上述指标构建的列线图模型预测老年脓毒症患者30 d内死亡风险的ROC曲线下面积(AUC)为0.777(95%CI=0.743~0.810),外部验证预测死亡风险的AUC为0.747(95%CI=0.733~0.762),内部与外部校准曲线均贴近标准曲线。结论:本列线图模型具有良好的区分度及校准度,可较准确预测老年脓毒症死亡预后,为临床医师评估老年脓毒症患者预后提供依据。Objective:To explore the risk factors affecting the prognosis of death in elderly patients with sepsis,and to construct a nomogram to predict the risk of short-term in-hospital death in elderly patients with sepsis.Methods:The clinical data of elderly sepsis patients from the Second Affiliated Hospital of Wenzhou Medical University and a large multi-center intensive care database in the United States were collected,and the relevant clinical data of patients,such as vital signs,laboratory tests and clinical outcomes,were retrospectively analyzed.Univariate and multivariate Logistic regression analysis was used to screen out risk factors and a nomogram model was constructed to predict death of elderly patients with sepsis within 30 days.Results:The lowest blood oxygen saturation on the first day of admission,the lowest mean arterial pressure,the highest heart rate,the lowest body temperature,the highest respiratory rate,the lowest blood albumin,the highest blood bilirubin,lactate,and brain natriuretic peptide(BNP),mechanical Ventilation,age,liver failure and history of metastatic malignant tumors were independent risk factors for elderly patients with sepsis.The area under the ROC curve(AUC)of nomogram was 0.777(95%CI=0.743-0.810),and the AUC for predicting the risk of death by external validation was 0.747(95%CI=0.733-0.762),with both the internal and external calibration curves close to the standard curve.Conclusion:This nomogram has good differentiation and calibration and can accurately predict the death prognosis of elderly patients with sepsis,which provides a basis for clinicians to evaluate the prognosis of elderly patients with sepsis.

关 键 词：脓毒症 死亡风险 预后 列线图 

分 类 号：R453.9[医药卫生—治疗学]