特重度烧伤患者死亡的风险预测模型构建  

Construction of a risk prediction model for mortality in patients with super severe burns

作　　者：李云 张庭 宁金斌 赵旭 董毓敏 周琴 Li Yun;Zhang Ting;Ning Jinbin;Zhao Xu;Dong Yumin;Zhou Qin(Department of Burns and Plastic Surgery,The Second Affiliated Hospital of Air Force Medical University,Xi'an 710036,China)

机构地区：[1]空军军医大学第二附属医院烧伤整形科,西安710036

出　　处：《保健医学研究与实践》2024年第12期108-113,共6页Health Medicine Research and Practice

基　　金：陕西省重点研发计划项目(2023-YBSF-578)。

摘　　要：目的分析特重度烧伤患者死亡的影响因素,并构建风险预测模型,以期为临床治疗开拓新思路。方法选取2021年1月—2024年3月西安某医院收治的108例特重度烧伤患者作为研究对象,收集患者临床资料。并根据患者入院90 d的生存情况分为生存组与死亡组,比较2组患者人口学资料,烧伤面积占总体表面积(TBSA)比例,入院时及入院3 d、入院7 d序贯器官衰竭估计(SOFA)评分及血小板计数等诊疗相关指标差异,使用多因素logistic回归分析筛选特重度烧伤患者死亡的独立影响因素,并利用列线图构建特重度烧伤患者死亡预测模型。结果108例特重度烧伤患者入院90 d内死亡率为17.59%(19/108)。死亡组患者烧伤面积占TBSA比例≥70%的人数占比及Ⅲ°烧伤面积占TBSA比例≥30%的人数占比、机械通气率、入院3 d SOFA评分≥2分的人数占比均高于生存组,入院7 d血小板计数正常的人数占比低于生存组,差异均有统计学意义(P<0.05)。logistic回归分析结果显示Ⅲ°烧伤面积占TBSA比例≥30%、机械通气、入院3 d SOFA评分≥2分均为特重度烧伤患者入院90 d内死亡的独立危险因素(OR=5.342、5.298、22.794,P<0.05)。以上述3项独立危险因素构建特重度烧伤患者死亡风险的列线图预警模型,Bootstrap法重复抽样对列线图模型进行内部验证,校准曲线趋近于理想曲线;受试者工作特征(ROC)曲线显示曲线下面积(AUC)为0.883(95%CI:0.784~0.982,P<0.05)。结论Ⅲ°烧伤面积、机械通气及入院3 d SOFA评分是特重度烧伤患者死亡的影响因素,三者构建的预测模型可辅助临床预测患者死亡风险,对指导诊疗有利。Objective To analyze the influencing factors of mortality in patients with super severe burns and construct a risk pre-diction model to provide new ideas for clinical treatment.Methods A total of 108 patients with super severe burns admitted to a hospital in Xi'an from January 2021 to March 2024 were selected as the study participants.According to the 90-day survival status after admission,the patients were allocated to a survival group and a death group.The differences in demographic data,proportion of Total Body Surface Area(TBSA)affected by burns,Sequential Organ Failure Assessment(SOFA)scores at ad-mission,3 days after admission,and 7 days after admission,and platelet counts between the two groups were compared.Mul-tivariate logistic regression analysis was used to identify independent influencing factors for mortality in patients with super se-vere burns,and a nomogram was constructed to predict mortality in these patients.Results The mortality rate within 90 days of admission for the 108 patients with super severe burns was 17.59%(19/108).The proportion of TBSA affected by burns of≥70%and proportion of TBSA affected by third-degree burn of≥30%,the rate of mechanical ventilation,and the propor-tion of patients with a SOFA score of≥2 at 3 days after admission were higher in the death group than in the survival group.In contrast,the proportion of patients with normal platelet counts at 7 days after admission was significantly lower in the death group than in the survival group(P<0.05).Logistic regression analysis revealed that the proportion of TBSA affected by third-degree burn of≥30%,mechanical ventilation,and a SOFA score of≥2 at 3 days after admission were independent risk factors for mortality within 90 days of admission for patients with super severe burns(OR=5.342,5.298,22.794,P<0.05).A nomogram prediction model for mortality risk in patients with super severe burns was constructed based on these three independent risk factors.The Bootstrap method was used for internal validation of the nomogr

关 键 词：烧伤 特重度 预后 死亡 序贯器官衰竭估计 机械通气 

分 类 号：R644[医药卫生—外科学]