严重多发外伤患者并发脓毒症的危险因素及风险预测模型构建  

Risk Factors and Risk Prediction Model Construction for Sepsis in Patients with Severe Multiple Trauma

作　　者：曲军[1] 吴金海[1] 胡润武 QU Jun;WU Jinhai;HU Runwu(Department of Emergency Trauma Surgery,Nanyang First People’s Hospital,Nanyang 473000,China)

机构地区：[1]南阳市第一人民医院急诊创伤外科,河南南阳473000

出　　处：《河南医学研究》2024年第9期1598-1601,共4页Henan Medical Research

摘　　要：目的分析严重多发外伤患者并发脓毒症的危险因素,并建立风险预测模型。方法收集南阳市第一人民医院2021年1月至2022年12月收治的120例严重多发外伤患者临床资料进行回顾性分析,依据是否并发脓毒症分为脓毒症组41例与非脓毒症组79例。采用logistic回归分析影响严重多发外伤患者并发脓毒症的危险因素,依据回归分析结果构建风险预测模型,并计算一致性指数(C-index)判断模型区分度。结果脓毒症组年龄、中性粒细胞与淋巴细胞计数比值(NLR)、活化部分凝血活酶时间(APTT)、创伤严重程度评分(ISS)、序贯器官衰竭(SOFA)评分均大于非脓毒症组,机械通气患者占比高于非脓毒症组,差异有统计学意义(P<0.05);经logistic回归分析显示,NLR、APTT、ISS评分为严重多发外伤患者并发脓毒症的独立危险因素(OR>1,P<0.05);绘制列线图构建严重多发外伤患者并发脓毒症的风险预测模型,验证模型区分度显示C-index值=0.908,区分度良好;绘制标准曲线显示,校准曲线和Y-X直线紧密贴合,模型准确度良好。结论NLR、APTT、ISS评分为严重多发外伤患者并发脓毒症的危险因素,基于上述因素构建的风险预测模型对严重多发外伤患者并发脓毒症具有较高预测价值。Objective To analyze the risk factors of sepsis in patients with severe multiple trauma and establish a risk prediction model.Methods A retrospective analysis was conducted on the clinical data of 120 patients with severe multiple trauma admitted to Nanyang First People’s Hospital from January 2021 to December 2022.They were divided into a sepsis group of 41 cases and a non sepsis group of 79 cases based on whether they were complicated with sepsis.Logistic regression analysis was used to analyze the risk factors of sepsis in severe multiple trauma patients.Based on the regression analysis results,a risk prediction model was constructed,and the consistency index(C-index)was calculated to determine the model differentiation.Results The age,neutrophil to lymphocyte ratio(NLR),activated partial thromboplastin time(APTT),injury severity score(ISS)and sequential organ failure assessment(SOFA)score of the sepsis group were all higher than those of the non sepsis group,and the proportion of mechanical ventilation patients was higher than that of the non sepsis group,with a statistical significant difference(P<0.05).Logistic regression analysis showed that NLR,APTT,and ISS were independent risk factors for sepsis in patients with severe multiple trauma(OR>1,P<0.05).A nomogram was drawn to construct a risk prediction model for sepsis in patients with severe multiple trauma.The discrimination of the model showed that the C-index value was 0.908,and the discrimination was good.The standard curve showed that the calibration curve and the Y-X straight line were closely fitted,and the model accuracy was good.Conclusion NLR,APTT,and ISS are risk factors for sepsis in patients with severe multiple trauma.The risk prediction model constructed based on these factors has high predictive value for sepsis in patients with severe multiple trauma.

关 键 词：脓毒症 严重多发外伤 危险因素 风险预测模型 创伤严重程度评分 

分 类 号：R459.7[医药卫生—急诊医学]