控制营养状态评分对老年脓毒症进展为慢重症的预测价值  

Predictive value of controlling nutritional status score for progression to chronic critical illness in elderly patients with sepsis

作　　者：王晓苗 柴豆豆 邢柏[2] WANG Xiao-miao;CHAI Dou-dou;XING Bo(Emergency and Trauma College of Hainan Medical University,Haikou 571199,China;Department of Emergency,the Second Affiliated Hospital of Hainan Medical University,Haikou 570311,China)

机构地区：[1]海南医学院急诊创伤学院,海南海口571199 [2]海南医学院第二附属医院急诊科,海南海口570311

出　　处：《海南医学院学报》2023年第23期1801-1808,共8页Journal of Hainan Medical University

基　　金：海南省自然科学基金项目(819MS128)。

摘　　要：目的:探讨控制营养状态(controlling nutritional status,CONUT)评分对老年脓毒症进展为慢重症的预测价值,并构建基于CONUT评分列线图预测模型。方法:选取海南医学院第二附属医院重症监护室2020年1月~2022年12月收治的739例老年脓毒症患者为研究对象,根据是否发生慢重症分为慢重症组(n=188例)和非慢重症组(n=551例),收集患者的临床资料并进行比较。比较CONUT评分、PNI和NLR在老年脓毒症进展为慢重症的预测价值,并确定最佳界值,采用最佳界值将数值型变量转化为二分类变量;通过单因素分析和多因素Logistic回归分析筛选出影响老年脓毒症患者进展为慢重症的危险因素,并以此构建列线图预测模型;通过受试者工作特征(ROC)曲线下面积(AUC)、校准曲线和决策曲线分析法(DCA)评价预测模型效能和临床实用性。结果:CONUT评分在预测老年脓毒症进展为慢重症的最佳界值为4分,对老年脓毒症进展为慢重症的预测效能(AUC=0.739)优于PNI(AUC=0.609)和NLR(AUC=0.582),差异具有统计学意义(CONUT评分比PNI:Z=5.960,P<0.001;CONUT评分比NLR:Z=6.119,P<0.001)。单因素分析结果显示年龄、CCI评分、SOFA评分、脓毒症休克、血清Lac、CONUT评分、行MV和CRRT治疗在老年脓毒症进展为慢重症具有相关性(P<0.05)。多因素Logistic回归分析结果显示,CONUT评分≥4分、年龄≥75岁、CCI评分≥3分、SOFA评分>5分、脓毒症休克和血清Lac≥4 mmol/L是老年脓毒症进展为慢重症的独立危险因素(P<0.05)。列线图结果显示CONUT评分预测老年脓毒症进展为慢重症的贡献价值最大,基于此构建的列线图预测模型AUC为0.846[95%CI(0.812~0.879)],敏感度为75.5%,特异度为81.3%,提示该预测模型效能较好;校准曲线接近于理想曲线,DCA阈值在0.1~0.9之间时具有临床实用性优势。结论:基于CONUT评分构建的老年脓毒症进展为慢重症的列线图预测模型能够有效的预测老年脓毒�Objective:To investigate the predictive value of controlling nutritional status(CONUT)score for progression to chronic critical illness sepsis in elderly patients,and to construct a predictive model based on CONUT score histogram.Meth⁃ods:Totally 739 elderly patients with sepsis admitted to the ICU of the Second Affiliated Hospital of Hainan Medical University from January 2020 to December 2022 were selected as the research subjects, and were divided into chronic critical illness group (n=188) and non⁃chronic critical illness group (n=551) according to whether chronic critical illness disease occurred. Clinical dataof the patients were collected and compared. The predictive value of CONUT score, PNI and NLR in the progression of senilesepsis to chronic severe disease was compared, and the optimal threshold value was determined, which was used to convert the nu⁃merical variables into binary variables. Through univariate analysis and multivariate Logistic regression analysis, the risk factors af⁃fecting the progression of elderly sepsis patients to chronic critical illness disease were screened out, and the prediction model wasbuilt based on the nomogram. The efficacy and clinical utility of the prediction model were evaluated by the area under the ROCcurve(AUC), calibration curve and decision curve analysis( DCA). Results: The best cut⁃off value for CONUT score in predict⁃ing elderly sepsis progressing to chronic critical illness was 4. The predictive performance of CONUT score (AUC=0.739) wasbetter than that of PNI( AUC=0.609) and NLR( AUC=0.582) in elderly sepsis progressing to chronic critical illness( CONUTscore vs. PNI: Z=5.960, P<0.001;CONUT score vs NLR: Z=6.119, P<0.001). Univariate analysis showed that age, CCIscore, SOFA score, sepsis shock, serum Lac, CONUT score, mechanical ventilation (MV), and continuous renal replacementtherapy( CRRT) treatment were related to elderly sepsis progressing to chronic critical illness( P<0.05). Multivariate logistic re⁃gression analysis showed that CONUT s

关 键 词：脓毒症 慢重症 CONUT评分 列线图 预测模型 

分 类 号：R459.7[医药卫生—急诊医学]