基于NEWS评分的脓毒症患者预后列线图的建立与验证

 目的 建立国家早期预警评分(NEWS)联合相关指标预测脓毒症患者预后的列线图,为临床医生提供更加准确的预测模型,改善脓毒症患者的预后。方法 回顾性收集2019年1月—2021年12月某院急诊重症监护病房(EICU)、外科重症监护病房(SICU)和内科重症监护病房(MICU)收治的脓毒症患者临床资料,随机将符合纳入标准的患者分为训练组和验证组。对训练组中死亡组与存活组患者进行单因素及多因素分析,比较两组患者临床表现及实验室指标的差异,采用其独立危险因素构建列线图,并验证准确性。结果 最终纳入330例患者,训练组和验证组两组患者基线资料比较,差异均无统计学意义(均P>0.05)。训练组中死亡组与存活组单因素及多因素分析结果显示,NEWS评分(OR=1.70,95%CI:1.36~2.14)、合并呼吸衰竭(OR=3.82,95%CI:1.13~12.92)、病程中使用呼吸机(OR=0.26,95%CI:0.09~0.80)、红细胞分布宽度(OR=1.25,95%CI:1.05~1.50)、乳酸值(OR=1.55,95%CI:1.27~1.91)是影响脓毒症患者30天预后的独立危险因素。评估与验证预后列线图模型显示,训练组与验证组的C-index分别为0.903、0.905。两组间的校准曲线均与理想曲线拟合较好,受试者工作特征曲线下面积分别为0.916、0.899,表明该模型具有良好的预测效能。决策曲线分析显示,列线图在训练组与验证组有极高的临床获益性。结论 影响脓毒症患者预后的相关因素较多,联合最具价值的影响因素,构建基于NEWS评分预测脓毒症患者预后的列线图,预测性能较好,可进一步为临床医生提供简单有效的评估方式,提高预测准确度。

Establishment and validation of nomogram for prognosis of patients with sepsis based on national early warning score

Objective To establish a nomogram of national early warning score (NEWS) combined with relevant indicators to predict the prognosis of patients with sepsis, so as to provide clinicians with a more accurate prediction model and improve the prognosis of patients with sepsis. Methods Clinical data of patients with sepsis who admitted to emergency intensive care unit (EICU), surgical intensive care unit (SICU) and medical intensive care unit (MICU) of a hospital from January 2019 to December 2021 were retrospectively collected, those who met the inclusion criteria were randomly divided into test group and verification group. In test group, patients in death group and survival group were analyzed by univariate and multivariate analysis, differences in clinical manifestations and laboratory indicators between two groups of patients were compared, the nomogram was constructed based on its independent risk factors, the accuracy was verified. Results A total of 330 patients were finally included in analysis, there was no significant difference in the baseline data between test group and verification group (all P>0.05). Univariate and multivariate analysis results of death group and survival group in test group showed that NEWS (OR=1.70, 95%CI: 1.36-2.14), combined with respiratory failure (OR=3.82, 95%CI: 1.13-12.92), ventilator use during disease course (OR=0.26, 95%CI: 0.09-0.80), red blood cell distribution width (OR=1.25, 95%CI: 1.05-1.50), and lactic acid value (OR=1.55, 95%CI: 1.27-1.91) were independent risk factors affecting the 30-day prognosis of patients with sepsis. The nomogram model for evaluation and validation of prognosis showed that the C-index of test group and validation group were 0.903 and 0.905 respectively, the calibration curves between two groups fit well with the ideal curve, and the areas under receiver operating characteristic curve were 0.916 and 0.899 respectively, indicating that the model has good prediction efficiency. Decision curve analysis showed that nomogram had high clinical benefit in test group and validation group. Conclusion There are multiple relevant factors affecting the prognosis of patients with sepsis, combined with the most valuable influencing factors, a nomogram for predicting the prognosis of patients with sepsis based on NEWS has good prediction performance, which can further provide clinicians with a simple and effective evaluation method, improve the prediction accuracy.