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[在重症监护室治疗败血症患者的预后模型的开发和验证]
Ziming Jiang1, Hongliang Wang2, Sumei Wang2
1Dalian Medical University, Dalian 116000, Liaoning, China.
Zhonghua wei zhong bing ji jiu yi xue
|August 18, 2023
概括
这项研究确定了在重症监护病房 (ICU) 中败血症死亡率的关键风险因素. 开发了一种预测性诺莫格拉姆模型,在预测患者结果方面表现出很好的准确性,并协助治疗败血症的临床决策.
科学领域:
- 关键护理医学 关键护理医学
- 败血症病理生理学病理生理学
- 临床预后 临床预后
背景情况:
- 败血症是一种危及生命的器官功能障碍,是由宿主对感染反应失调引起的.
- 在重症监护室 (ICU) 治疗败血症患者的准确预后对于及时干预和资源分配至关重要.
研究的目的:
- 为了确定与ICU患者的败血症预后相关的风险因素.
- 开发和验证一个nomogram模型,用于预测ICU中的败血症相关死亡率.
主要方法:
- 使用MIMIC-IV数据库 (2.0版本) 对6500名败血症患者进行了回顾性队列研究.
- 拉索回归和多变量考克斯回归分析,以确定重大风险因素.
- 使用一致性指数,校准曲线和ROC曲线构建和验证名图.
主要成果:
- 确定的危险因素包括年龄,SOFA评分,SAPS II评分,MAP,RR,并发病 (脑血管疾病,恶性瘤,严重肝病),血管活性药物使用,PaO2,Lac,BUN,TBil和PT.
- 在培训组中,开发的诺米图表表现出了良好的预测性能,AUC为0.771的28天死亡率.
- 决策曲线分析证实了诺姆图的临床实用性和对决策的积极影响.
结论:
- 年龄,SOFA,SAPS II,MAP,RR,特定的并发症,血管活性药物使用以及关键的实验室参数是败血症死亡率的重要预测因素.
- 构建的名图为预测患有败血症的ICU患者死亡风险提供了可靠的工具.
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