基于重症监护医学信息数据库-Ⅳ分析低三碘甲状腺原氨酸综合征与脓毒症患者病死率的相关性  

Correlation between low triiodothyronine syndrome and mortality in septic patients based on med-ical information mart for intenive care-Ⅳdatabase

作　　者：徐跃文 陈福进 赵晶晶 姚莉 Xu Yuewen;Chen Fujin;Zhao Jingjing;Yao Li(Department of Critical Care Medicine,the Second People’s Hospital of Hefei,Affiliated to Bengbu Medi-cal College,Hefei 230011,China)

机构地区：[1]蚌埠医学院附属合肥市第二人民医院重症医学科,合肥230011

出　　处：《临床内科杂志》2024年第3期179-183,共5页Journal of Clinical Internal Medicine

摘　　要：目的探讨低三碘甲状腺原氨酸(T_(3))综合征对脓毒症患者病情严重程度及预后的影响。方法纳入重症监护医学信息数据库-Ⅳ(MIMIC-Ⅳ)中的脓毒症患者963例,根据T_(3)水平将其分为低T_(3)组488例(T_(3)<80 ng/dl)及非低T_(3)组475例(T_(3)≥80 ng/dl)。收集所有患者的一般资料、合并症、实验室检查指标、危重度评分、入ICU 24 h内是否接受机械通气或肾脏替代治疗情况、预后情况并进行组间比较。采用局部加权回归(Lowess)拟合整体死亡率趋势的曲线。采用多因素logistic回归分析评估影响脓毒症合并低T_(3)综合征患者死亡的危险因素。构建列线图预测模型,采用受试者工作特征(ROC)曲线分析该模型的预测效能,采用Hosmer-Lemeshow(H-L)检验对列线图模型的拟合度进行验证。结果低T_(3)组年龄、慢性心力衰竭、机械通气、肾脏替代治疗患者比例、序贯器官衰竭评估(SOFA)评分、急性生理学评分(APS)Ⅲ、WBC计数、中性粒细胞与淋巴细胞比值(NLR)、血肌酐(SCr)、血乳酸(Lac)均显著高于非低T_(3)组,T_(3)、甲状腺素(T_(4))、游离甲状腺素(FT_(4))及氧合指数均显著低于非低T_(3)组(P<0.05)。低T_(3)组28 d死亡、365 d死亡、ICU死亡、院内死亡患者比例及入住ICU时间、住院时间均高于非低T_(3)组(P<0.05)。Lowess曲线分析结果显示,T_(3)水平越低,脓毒症患者28 d死亡率、365 d死亡率、ICU死亡率及院内死亡率越高。多因素logistic回归分析结果显示,低T_(3)水平、SOFA评分、APSⅢ及年龄均是脓毒症合并低T_(3)综合征患者的独立危险因素(P<0.05)。构建列线图预测模型并绘制预测模型ROC曲线,结果显示预测模型的预测效能优于各独立危险因素单独预测。H-L检验结果显示模型拟合度良好,具备较高的预测价值(P=0.119)。结论低T_(3)综合征与脓毒症患者死亡风险增加相关,T_(3)水平对其预后有重要的预测价值。Objective To investigate the effect of low triiodothyronine(T_(3))syndrome on the se-verity and prognosis of sepsis.Methods A total of 963 patients with sepsis were included in the medical information mart for intenive care-Ⅳ(MIMIC-Ⅳ).According to T_(3)levels,they were divided into low T_(3)group(488 cases,T_(3)<80 ng/dl)and non-low T_(3)group(475 cases,T_(3)≥80 ng/dl).General data,comor-bidities,laboratory test indicators,severity scores,whether received mechanical ventilation or renal re-placement therapy within 24 h after admission to ICU and prognosis were collected and compared between groups.Local weighted regression(Lowess)was used to fit the curve of overall mortality trend.Multivariate logistic regression analysis was used to evaluate the risk factors for death in patients with sepsis and low T_(3)syndrome.Construct a nomogram prediction model,receiver operating characteristic(ROC)curve was used to analyze the predictive efficiency of the model,Hosmer-Lemeshow(H-L)test was used to verify the fitting degree of the nomogram model.Results Age,proportion of patients with chronic heart failure,mechanical ventilation,renal replacement therapy,sequential organ failure assessment(SOFA)score,acute physiologi-cal score(APS)Ⅲ,WBC count,neutrophil to lymphocyte ratio(NLR),serum creatinine(SCr)and lactic acid(Lac)in low T_(3)group were significantly higher than those in non-low T_(3)group,T_(3),thyroxine(T_(4)),free thyroxine(FT_(4))and oxygenation index were significantly lower than those in non-low T_(3)group(P<0.05).The proportion of 28 d death,365 d death,ICU death,hospital death,ICU stay and hospital stay in low T_(3)group were higher than those in non-low T_(3)group(P<0.05).Lowess curve analysis result showed that the lower T_(3)level,the higher 28 d mortality,365 d mortality,ICU mortality and in-hospital mortality of sepsis patients.Multivariate logistic regression analysis showed that low T_(3)level,SOFA score,APSⅢand age were independent risk factors for sepsis with low T_(3)syndrome(P<0.05).A nomo

关 键 词：低三碘甲状腺原氨酸综合征 脓毒症 预后 重症监护医学信息数据库 

分 类 号：R581[医药卫生—内分泌]