系统性免疫炎症指数的早期24小时变化预测了ICU患者的急性损伤和死亡率
Fei Gao1, Lan Yang1, Yizhe Chen1
1Department of Critical Care Medicine, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Nanjing, China.
Emergency medicine international
|August 28, 2025
概括
系统性免疫炎症指数 (SII) 的早期变化预测严重病患者的急性损伤 (AKI) 和死亡率. 动态SII指标,特别是24小时斜率,提高风险分层,以获得更好的患者结果.
科学领域:
- 危急护理医学
- 肝脏病学
- 免疫学
背景情况:
- 在重症患者中,急性损伤 (AKI) 和死亡率是重大问题.
- 这些结果的预测模型往往需要改进以提高准确性.
研究的目的:
- 调查系统性免疫炎症指数 (SII) 的早期动态变化是否有助于预测重症监护室 (ICU) 患者的AKI和1年死亡率.
- 开发和验证一个包含SII指标的预测名录,以改善风险分层.
主要方法:
- 来自MIMIC- IV数据库的17,491例ICU住院病人的回顾性队列研究.
- 在前24小时内计算三个SII指标:24小时SII_slope,SII_min和SII_max.
- 使用LASSO选择的逻辑回归来预测AKI和Cox模型的死亡率,并进行名图开发和性能评估 (AUC,校准,DCA).
主要成果:
- 较的24小时SII_slope被确定为AKI的独立预测指标 (AUC为0.739).
- 较高的SII_min和SII_max与1年生存率的降低有关 (SII_min四分位数的逻辑等级p=0. 047).
- 开发的诺米图表显示出1年死亡率的优异区别 (AUC为0.823) 具有良好的校准和临床效用.
结论:
- 早期SII的动态变化,特别是24小时的斜率和第一天的极端,可以独立预测ICU患者的AKI和长期死亡率.
- 一个整合SII指标与标准严重性评分的nomogram为重症监护机构的个性化风险分层提供了有价值的工具.
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