基于下肢皮肤花斑评分的预测模型对脓毒症患者预后的判断价值

Prognostic value of a predictive model based on lower limb skin mottling score in determining the prognosis of patients with sepsis

目的建立并分析基于下肢皮肤花斑评分(SMS)的联合预测模型对脓毒症患者入住ICU后转归的预测价值。方法采用多中心前瞻性、观察性研究方法,选取福建省4所三级甲等医院的6个ICU于2019年3月1日至12月31日收治的458例首诊为脓毒症患者作为研究对象。收集人口学资料、临床生化指标、下肢SMS、序贯器官衰竭评分(SOFA)、急性生理学及慢性健康状况评分(APACHEⅡ)等资料,采用二分类Logistic回归分析脓毒症患者入住ICU后转归的影响因素,构建联合预测模型,绘制ROC曲线,进行下肢SMS与联合预测模型预测效能比较。结果Logistic多因素回归分析显示,下肢SMS、SOFA、APACHEⅡ、乳酸、平均动脉压是脓毒症患者ICU后转归的影响因素(均P<0.05)。下肢SMS预测ICU转归风险的曲线下面积为0.718(95%CI 0.675~0.959,P<0.01),灵敏度为51.96%,特异度为85.11%。构建基于下肢SMS的联合预测模型,对脓毒症患者ICU转归的预测能力为曲线下面积为0.835(95%CI 0.762~0.878,P<0.001),灵敏度为81.40%,特异度为73.00%,均具有统计学意义(P<0.05)。结论基于下肢SMS构建的联合预测模型能较为准确的预测脓毒症患者ICU转归,可成为护理人员评估脓毒症患者预后的一项新的护理评估手段,帮助护理人员更加精准的制定临床护理决策,降低病死率。

Objective To develop and analyze the predictive value of a combined predictive model based on the lower limb skin mottling score(SMS)for the outcome of sepsis patients admitted to ICU.Methods Using a multicenter prospective,observational study,458 patients admitted to six ICUs in 4 grade A tertiary hospitals in Fujian Province from March 1,2019 to December 31,2019 with first diagnosis of sepsis were selected as study subjects.Demographic data,clinical biochemical indexes,lower limb SMS,Sequential Organ Failure Assessment(SOFA),and Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)were collected.Binary Logistic regression was used to analyze the outcome of patients with sepsis after admission to ICU,a joint prediction model was constructed,ROC curves were drawn,and a comparison of the predictive efficacy of the lower limb SMS and the joint prediction model was performed.Results Logistic multifactorial regression analysis showed that lower limb SMS,SOFA score,APACHEⅡscore,lactate,mean arterial pressure were the influencing factors of outcome of patients with sepsis after admission to ICU(all P<0.05).The area under the curve of lower limb SMS predicted ICU outcome risk was 0.718(95%CI 0.675-0.959,P<0.001)with the sensitivity of 51.96%and specificity of 85.11%.The area under the curve of predictive ability of the combined model based on the lower limb SMS for ICU outcome of sepsis patients was 0.835(95%CI 0.762-0.878,P<0.01)with the sensitivity of 81.40%and specificity of 73.00%,the difference was significant(P<0.05).Conclusions The combined prediction model based on lower limb SMS can more accurately predict the prognosis of sepsis patients after admission to ICU,which can be a new nursing assessment tool for nurses to evaluate the prognosis of sepsis patients and help nurses to make more accurate clinical care decisions and reduce the morbidity and mortality rate.