预测普通病房中丙型肝炎肝硬化并脓毒症患者潜在死亡列线图的建立及评价  

Establishment and Evaluation of a Nomogram for Predicting Potential Death in Patients with Hepatitis C Cirrhosis and Sepsis in General Wards

作　　者：薛淋淋 李秉翰 刘春云 李卫昆 常丽仙 李慧敏 祁燕伟 刘立 XUE Linlin;LI Binghan;LIU Chunyun;LI Weikun;CHANG Lixian;LI Huimin;QI Yanwei;LIU Li(School of Public Health,Dali University,Dali Yunnan 671000;Dept.of Liver Diseases and Immunology,Yunnan Provincial Clinical Medical Center for Infectious Diseases,The Third People’s Hospital of Kunming,Kunming Yunnan 650041,China)

机构地区：[1]大理大学公共卫生学院,云南大理671000 [2]昆明市第三人民医院肝病免疫科,云南省传染病临床医学中心,云南昆明650041

出　　处：《昆明医科大学学报》2023年第6期113-119,共7页Journal of Kunming Medical University

基　　金：佑安专科联盟科研专项基金(LM202014)。

摘　　要：目的探讨普通病房中丙型肝炎肝硬化并脓毒症患者潜在死亡的预测影响因素。方法回顾性分析2012年1月至2022年8月昆明市第三人民医院诊断明确的194例丙型肝炎肝硬化并脓毒症患者作为研究对象,收集患者入院时的性别、年龄、基础疾病、感染部位、近2周有创操作史、MEWS评分、住院天数、白细胞/血小板、中性粒细胞计数/淋巴细胞计数比值(NLR)、红细胞、凝血酶原时间等临床资料。根据预后情况分为两组:死亡组(n=13),生存组(n=181),分析并比较2组各类指标差异,分析死亡的影响因素。结果194例符合诊断的患者被纳入分析,男性151例(77.8%),女性43例(22.2%);平均年龄(50.6±9.7)岁;合并高血压32例(16.5%),合并糖尿病32例(16.5%)。多因素Logistic回归分析,感染HCV时间(OR=1.114;95%CI1.000,1.241)、MEWS评分(OR=1.761;95%CI 1.210,2.564)、未合并感染(OR=0.081;95%CI 0.010,0.667)、中性粒细胞/淋巴细胞比值(NLR)(OR=1.084;95%CI 1.021,1.152)是普通病房中丙型肝炎肝硬化并脓毒症患者潜在死亡的独立影响因素。列线图模型的灵敏度92.3%,特异度81.2%,最大约登指数为0.735。霍斯默-莱梅肖检验,χ^(2)=2.471,P=0.963(P>0.05),表明模型的拟合程度较好。ROC曲线分析显示AUC=0.916,95%CI(0.856,0.976),校准曲线Calibrated图进行验证Nomogram模型诊断价值,平均绝对误差0.022,结果显示细菌感染发生的实际值和预测值之间有较好的一致性。结论感染HCV时间、MEWS评分、未合并感染、NLR与丙型肝炎肝硬化并脓毒症发生死亡风险有相关性。MEWS联合诊断可以提高对普通病房丙肝肝硬化并脓毒症患者是否死亡预测的准确性。Objective To explore the predictive factors of potential mortality in patients with hepatitis C cirrhosis and sepsis in general wards.Methods A retrospective analysis was performed on 194 patients with hepatitis C cirrhosis and sepsis diagnosed in the Third People’s Hospital of Kunming City from January 2012 to August 2022.Clinical data such as gender,age,comorbidity,site of infection,history of invasive operation within the last 2 weeks,MEWS score,length of stay,white blood cell/platelet,neutrophil count/lymphocyte count ratio(NLR),red blood cell and prothrombin time were collected.According to the prognosis,the patients were divided into two groups:death group(n=13)and survival group(n=181).The differences of various indicators between the two groups were analyzed and compared,and the influencing factors of death were analyzed.Results A total of 194 patients were included in the analysis,including 151 males(77.8%)and 43 females(22.2%).The average age was 50.6±9.7 years.There were 32 cases(16.5%)with hypertension and 32 cases(16.5%)with diabetes.Multivariate Logistic regression analysis showed that HCV infection time(OR=1.114;95%CI 1.000,1.241),MEWS score(OR=1.761;95%CI 1.210,2.564),no co-infection(OR=0.081;95%CI 0.010,0.667),neutrophil/lymphocyte ratio(NLR)(OR=1.084;95%CI 1.021,1.152)was an independent predictor of potential death in patients with hepatitis C cirrhosis and sepsis in the general ward.The sensitivity and specificity of the nomogram model are 92.3%,81.2%,respectively;and the maximum Youden index is 0.735.The result of Hosmer-Lemeshaw test isχ^(2)=2.471,P=0.963(P>0.05),which indicates that the model fits well.ROC curve analysis showed that AUC=0.916,95%CI 0.856,0.976.Calibration images of the Nomogram was used to verify the diagnostic value of the Nomogram model with an average absolute error of 0.022.The results showed that the actual and predicted values of bacterial infection were in good consistency.Conclusion Time of HCV infection,MEWS score,unco-infected,and NLR were associated with the r

关 键 词：改良早期预警评分 脓毒症 丙型肝炎肝硬化 死亡 列线图 

分 类 号：R512.63[医药卫生—内科学]