脓毒症相关性血小板减少症的危险因素及预测模型建立  

Risk factors of sepsis-associated thrombocytopenia and the construction of prediction model

作　　者：刘一畅 郑恒恒 朱建军[1] 冯辉 姜煜浩 杜鑫 沈斌[1] Liu Yichang;Zheng Hengheng;Zhu Jianjun;Feng Hui;Jiang Yuhao;Du Xin;Shen Bin(Department of Emergency and Critical Care Medicine,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院急重症医学科,江苏苏州215004 [2]安徽省阜阳市人民医院急诊科,安徽阜阳236000

出　　处：《中国急救医学》2024年第8期672-677,共6页Chinese Journal of Critical Care Medicine

基　　金：苏州市姑苏卫生人才计划人才科研项目(GSWS2021017)。

摘　　要：目的探讨脓毒症患者发生血小板减少症的危险因素,并由此建立预测模型。方法回顾性收集2019年1月至2021年12月苏州大学附属第二医院重症监护病房(ICU)治疗的脓毒症患者临床资料,按照住院治疗期间是否并发血小板减少分为血小板减少组(n=187)和血小板正常组(n=193)。比较两组临床资料,将有统计学差异的指标进一步行Logistic回归分析筛选出与脓毒症患者发生血小板减少症相关的独立危险因素,并建立预测模型。利用受试者工作特征(ROC)曲线下面积(AUC)、校准曲线及临床决策曲线(DCA)对模型的预测效能及临床应用价值进行综合评估。结果共有380例脓毒症患者纳入研究,血小板减少组187例,血小板正常组193例。多因素Logistic回归分析筛选出大血小板比率(P-LCR)、降钙素原(PCT)及序贯器官衰竭评估(SOFA)评分是影响脓毒症患者发生血小板减少症的独立危险因素。基于这3个独立危险因素构建预测模型的ACU、敏感度和特异度分别为0.910、91.0%和73.5%。校准曲线表明,模型预测与实际观测结果具有良好一致性,证明了拟合模型的优越性。DCA显示,预测模型阈概率波动在0.01~0.93范围内,临床获益良好。结论P-LCR、PCT及SOFA评分是脓毒症患者发生血小板减少症的独立危险因素。基于3个独立危险因素建立的临床预测模型诊断效能较高,具有良好的临床实用性。Objective To study the risk factors of thrombocytopenia in the patients with sepsis and to construct the prediction model.Methods A retrospective study was conducted to collect the clinical data of sepsis patients admitted to the ICU of the Second Affiliated Hospital of Soochow University from January 2019 to December 2021,the patients were divided into throm bocytopenia group and normal group according to whether the thrombocytopenia occurred during hospitalization.The clinical data were compared between the two groups,and Logistic regression analysis was performed to screen out the independent risk factors associated with sepsis-associated thrombocytopenia,the prediction model was established based on independent risk factors.The area under the receiver operating characteristic(ROC)curve(AUC),calibration curve and decision curve analysis(DCA)were used to evaluate the predictive efficacy and clinical value of the model.Results A total of 380 patients with sepsis were enrolled in the study,187 with thrombocytopenia and 193 with normal platelet.Multivariate Logistic regression analysis identified platelet-larger cell ratio(P-LCR),procalcitonin(PCT)and sequential organ failure assessment(SOFA)scores as independent risk factors for sepsis-associated thrombocytopenia.The area under the curve(AUC),sensitivity and specificity of prediction model based on independent risk factors were 0.910,91.0%and 73.5%,respectively.The calibration curve showed that there was a good consistency between the prediction of the model and the results of actual observation.The superiority of the fitting model was proved.DCA showed that the clinical benefit ratio was good when the threshold probability of the predictive model fluctuated in the range of 0.01-0.93.Conclusions P-LCR,PCT and SOFA scores are independent risk factors for thrombocytopenia in sepsis.The clinical predictive model based on three independent risk factors has high diagnostic efficacy and good clinical practicability.

关 键 词：脓毒症 血小板减少症 危险因素 风险预测模型 大血小板比率 降钙素原 序贯器官衰竭评估 

分 类 号：R459.7[医药卫生—急诊医学]