ICU脓毒症休克致急性呼吸衰竭预后的影响因素及预测模型构建

Influencing factors and prediction model construction of the prognosis of acute respiratory failure caused by septic shock in ICU

目的 探讨重症监护室(ICU)脓毒症休克致急性呼吸衰竭(ARF)预后的影响因素及其预测模型的构建。方法 选取2016年9月至2020年12月收入ICU的脓毒症休克致ARF患者200例作为研究对象,根据预后分为不良组(60例)、良好组(140例),比较两组临床资料,分析预后的相关影响因素,并采用R语言绘制预测预后的列线图模型,采用区分度、校准度检验列线图的预测能力。结果 不良组静脉补充Omega-3鱼油患者少于良好组,序贯器官衰竭评估(SOFA)评分、急性生理和慢性健康状态(APACHEⅡ)评分高于良好组,血钙低于良好组(P<0.05);静脉补充Omega-3鱼油、SOFA评分、APACHEⅡ评分、血钙均与患者预后独立相关(HR=0.264、14.370、11.337、0.325,P<0.05);Cox回归分析列线图模型预测预后的C-index为0.885,外部验证显示,其区分度为0.826,校准度为0.844。结论 静脉补充Omega-3鱼油、SOFA评分、APACHEⅡ评分、血钙浓度为ICU脓毒症休克致ARF患者预后的重要影响因素,临床可结合上述因素对预后进行早期预测,针对性制定个体化干预措施,以降低不良预后发生风险。

Objective To investigate the prognostic factors of acute respiratory failure(ARF)caused by septic shock in intensive care unit(ICU)and to construct the predictive model.Methods A total of 200 patients with ARF caused by septic shock who were admitted to the ICU from September 2016 to December 2020 were selected as the research subjects.According to the prognosis,they were divided into a poor group(60 cases)and a good group(140 cases).The clinical data of the two groups were compared.Cox regression was used to analyze the related influencing factors of prognosis,R language was used to draw a nomogram model for predicting prognosis,and the degree of discrimination and calibration were used to test the predictive ability of the nomogram.Results The patients with intravenous supplementation of Omega-3 fish oil in the poor group were less than those in the good group,the SOFA score and APACHEⅡscore were higher than those in the good group,and the serum calcium was lower than that in the good group(P<0.05).The scores and serum calcium were independently correlated with the prognosis of patients(HR=0.264,14.370,11.337,0.325,P<0.05);the C-index of Cox regression analysis nomogram model for predicting prognosis was 0.885,and external validation showed that the degree of discrimination was 0.826 and the calibration degree was 0.844.Conclusion Intravenous supplementation of Omega-3 fish oil,SOFA score,APACHE II score,and blood calcium concentration are important prognostic factors for patients with ARF caused by septic shock in ICU.Clinically,the above factors can be combined to predict the prognosis early,and individualized intervention measures can be formulated to reduce the risk of poor prognosis.