脓毒性休克患者死亡风险早期精准评估预警模型的建立及研究  

Establishment and Research of an Early Precise Assessment and Early Warning Model for Mortality Risk in Septic Shock Patients

作　　者：罗小波[1] 蔡昆[2] 陈雪华 余天波 LUO Xiaobo;CAI Kun;CHEN Xuehua;Yu Tianbo(Department of Critical Care Medicine,Fourth People's Hospital of Zigong City,Zigong,Sichuan 643000,China;Department of Information,the Fourth People's Hospital of Zigong City,Zigong,Sichuan 643000,China)

机构地区：[1]四川省自贡市第四人民医院重症医学科,四川自贡643000 [2]四川省自贡市第四人民医院信息科,四川自贡643000

出　　处：《转化医学杂志》2024年第9期1408-1413,共6页Translational Medicine Journal

基　　金：自贡市重点科技计划项目(2022ZCYGY11)。

摘　　要：目的 通过数据分析建立血管活性药物评分(VIS)联合改良重症超声快速管理方案评分(MCS)以及降钙素原(PCT)预测脓毒性休克患者死亡的模型,并对模型进行评价和应用实践。方法 以回顾性整理2022年8月至2024年3月四川省自贡市第四人民医院重症医学科收治的脓毒性休克患者320例作为研究对象,根据患者预后情况,将28 d内死亡者纳入死亡组(n=48),生存者纳入存活组(n=272),多因素采用二元Logistics回归分析,并对显著的影响因素指标进行受试者工作特征(ROC)曲线分析。结果 VIS评分、MCS评分和PCT水平是脓毒症休克患者发生死亡的危险因素;脓毒性休克患者死亡的预测模型建立为:L=VIS+2.131×MCS+1.017×PCT;联合预测因子L对死亡的预测价值显著,曲线下面积(AUC)为0.991,P <0.05,截断值为131.15,灵敏度97.92%,特异度94.49%,结合AUC可得,预测价值大小排序为L>VIS>MCS>PCT。结论 VIS联合MCS及PCT预测脓毒性休克患者死亡的预测模型可运用于临床,对脓毒性休克的早期精准治疗有重要指导意义。Objective To establish a model for predicting the death of septic shock patients through data analysis by combining the vasoactive inotropic score(VIS),the Modified Critical Care Ultrasound Examination Score(MCS),and procalcitonin(PCT),evaluate and apply the model to guide the early treatment of septic shock patients.Methods A retrospective analysis of clinical data from 320 inpatients in the intensive care unit of Zigong Fourth People’s Hospital from August 2022 to March 2024 was used as the data source.Based on the patients'prognosis,those who died within 28 days were included in the Death Group(n=48),and those who survived were included in the Survival Group(n=272).Multivariate binary logistic regression analysis was used,and ROC curve analysis was performed on the significant influencing factor indicators for death.Results The VIS score,MCS score,and PCT level are risk factors for mortality in patients with septic shock.The predictive model for death in septic shock patients was established as follows:L=VIS+2.131×MCS+1.017×PCT.The combined predictive factor L had significant predictive value for death,with an AUC of 99.1%,P<0.05,a cutoff value of 131.15,a sensitivity of 97.92%,and a specificity of 94.49%.Based on the AUC,the order of predictive value was L>VIS>MCS>PCT.Conclusion The prediction model of Vasoactive Inotropic Score combined with Modified Critical Care Ultrasound Examination Score and procalcitonin for predicting death in septic shock patients can be applied in clinical practice and has important guiding significance for the early and precise treatment of septic shock.

关 键 词：休克 脓毒性 血管活性药物评分 改良重症超声快速管理方案评分 死亡 ROC曲线 

分 类 号：R631.4[医药卫生—外科学]