摘要
目的分析脓毒症患者住院死亡的危险因素并构建列线图的死亡风险预测模型。方法回顾性收集贝鲁特医疗中心急诊科2010年1月至2015年1月脓毒症患者的医疗记录,包括合并症、生命体征、实验室检查结果和复苏参数,将患者分为存活组和死亡组。使用单因素及多因素Logistic回归模型识别可能的危险因素并使用R软件构建列线图预测模型。结果本研究共纳入174例脓毒症患者,其中80例在住院期间死亡。与存活组比较,死亡组的脓毒性休克、慢性心力衰竭发生率更高,体温更低,中性粒细胞比例更低,淋巴细胞比例更高,中性粒细胞与淋巴细胞比值更低,泌尿系统感染发生率更低,肺感染发生率更高(P<0.05)。多因素Logistic回归分析显示,脓毒性休克、慢性心力衰竭及位于胃肠道、肺部的感染是影响脓毒症患者住院死亡的危险因素,而体温、中性粒细胞与淋巴细胞比值为其保护因素(P<0.05)。列线图受试者工作特征曲线下面积为0.828(95%CI=0.747~0.890),特异度为0.804,灵敏度为0.753。结论本研究识别出多项脓毒症患者住院死亡的危险因素(脓毒性休克、慢性心力衰竭及位于胃肠道、肺部的感染)及保护因素(体温、中性粒细胞与淋巴细胞比值),并构建了列线图的死亡风险预测模型。
Objective To analyze the risk factors of hospitalized death of sepsis patients and construct a nomogram prediction model for the risk of death.Methods Medical records of patients with sepsis were retrospectively collected from the emergency department of Beirut medical center from January 2010 to January 2015,including comorbidities,vital signs,laboratory tests and resuscitation parameters.All the patients were divided into survival group and death group.Univariate and multivariate Logistic regression models were used to identify possible risk factors,and R software was used to construct a nomogram prediction model.Results A total of 174 patients with sepsis were included in this study,and 80 cases of them died during hospitalization.Compared with the survival group,the death group had higher incidence of septic shock and chronic heart failure,lower body temperature,lower proportion of neutrophils,higher proportion of lymphocytes,lower neutrophil-to-lymphocyte ratio,lower incidence of urinary tract infection and higher incidence of pulmonary infection(P<0.05).The results of multivariate Logistic regression analysis showed that septic shock,chronic heart failure and infections in gastrointestinal tract and lung were the risk factors for hospitalized death of sepsis patients,while the body temperature,neutrophil-to-lymphocyte ratio were the protective factors(P<0.05).The area under the nomogram receiver operating characteristic curve was 0.828(95%CI=0.747-0.890),the specificity was 0.804,and the sensitivity was 0.753.Conclusion This study identified multiple risk factors(septic shock,chronic heart failure,and infections in the gastrointestinal tract and lung)and protective factors(body temperature,neutrophil-to-lymphocyte ratio)for hospitalized deaths in sepsis patients and constructed a nomogram mortality risk prediction model.
作者
郑晓东
张凯
ZHENG Xiaodong;ZHANG Kai(Suqian TCM Hospital,Suqian 223800,China)
出处
《临床医学研究与实践》
2021年第16期37-40,共4页
Clinical Research and Practice
