脓毒症相关性脑病早期危险因素预警预测模型的构建与分析

Construction and analysis of early warning and prediction model for risk factors of sepsis-associated encephalopathy

目的探讨脓毒症患者发生脓毒症相关性脑病(SAE)的流行病学特点,分析其危险因素并构建预测模型,为临床早期识别SAE患者及改善患者临床结局提供依据。方法采用回顾性研究,选择2022年2月至2023年2月新疆医科大学第一附属医院重症医学中心收治的脓毒症患者,根据是否发生SAE分为脓毒症组和SAE组;并以同期24例非脓毒症患者作为对照(非脓毒症组)。收集患者人口学资料,入重症监护病房(ICU)时的相关评分和实验室指标,以及预后指标等,采用单因素分析和多因素Logistic回归分析脓毒症及SAE的危险因素,并绘制受试者工作特征曲线(ROC曲线),评价各危险因素对脓毒症和SAE的预测价值。结果共纳入130例脓毒症患者,其中52例发生SAE,SAE发生率为40.00%。各组患者预后指标中ICU住院时间及总住院时间比较差异有统计学意义,住院费用、机械通气时间等比较差异无统计学意义。多因素Logistic回归分析显示,肺部感染〔优势比(OR)=46.817,95%可信区间(95%CI)为5.624~389.757,P=0.000〕、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ:OR=1.184,95%CI为1.032~1.358,P=0.016)、序贯器官衰竭评分(SOFA:OR=9.717,95%CI为2.618~36.068,P=0.001)、Charson合并症指数评分(CCI:OR=4.836,95%CI为1.860~12.577,P=0.001)、血红蛋白(Hb:OR=0.893,95%CI为0.826~0.966,P=0.005)、谷氨酰转肽酶(OR=1.026,95%CI为1.008~1.045,P=0.006)是ICU患者发生脓毒症的独立危险因素;肺部感染(OR=28.795,95%CI为3.296~251.553,P=0.002)、APACHEⅡ评分(OR=1.273,95%CI为1.104~1.467,P=0.001)、SOFA评分(OR=8.670,95%CI为2.330~32.261,P=0.001)、CCI(OR=5.141,95%CI为1.961~13.475,P=0.001)、Hb(OR=0.922,95%CI为0.857~0.993,P=0.031)、谷氨酰转肽酶(OR=1.020,95%CI为1.002~1.038,P=0.030)是脓毒症患者发生SAE的独立危险因素。ROC曲线分析显示,肺部感染、APACHEⅡ评分、SOFA评分、CCI、Hb、谷氨酰转肽酶对脓毒症预测的曲线下面积(AUC)分别为0.792、0.728、0.987、0.933、0.720、0.699;上述6个变量联合预测脓毒症的AUC为1.000,敏感度为100%,特异度为100%。肺部感染、APACHEⅡ评分、SOFA评分、CCI、Hb对SAE预测的AUC分别为0.776、0.810、0.907、0.917、0.758;上述5个变量联合预测SAE的AUC为0.975,敏感度为97.3%,特异度为93.1%。结论脓毒症并发脑病时病情更严重;合并肺部感染及Hb、APACHEⅡ评分、SOFA评分、CCI升高是脓毒症患者并发SAE的独立危险因素,上述5个指标联合对SAE的早期筛查和预防具有良好的预测价值。

Objective To investigate the epidemiological characteristics of sepsis-associated encephalopathy(SAE)in patients with sepsis,analyze its risk factors and build a prediction model,which provides evidence for early clinical identification of SAE patients and improvement of clinical outcomes.Methods A retrospective observational study was conducted.Sepsis patients admitted to the critical care medical center of the First Affiliated Hospital of Xinjiang Medical University from February 2022 to February 2023 were enrolled.According to whether SAE occurred,the patients were divided into sepsis group and SAE group.The 24 patients without sepsis in the same period were used as controls(non-sepsis group).Demographic data,relevant scores and laboratory test indicators at admission to intensive care unit(ICU),and prognostic indicators were collected.Univariate and multivariate Logistic regression analysis was used to analyze the risk factors for sepsis and SAE.Receiver operator characteristic curve(ROC curve)was drawn.The predictive value of each risk factor for sepsis and SAE.Results A total of 130 patients with sepsis were included,of which 52 had SAE,and the incidence of SAE was 40.00%.There were significant differences in the length of ICU stay and total length of stay among all groups,while there were no significant differences in hospitalization cost and mechanical ventilation time.Multivariate Logistic regression analysis showed that pulmonary infection[odds ratio(OR)=46.817,95%confidence interval(95%CI)was 5.624-389.757,P=0.000],acute physiology and chronic health evaluationⅡ(APACHEⅡ:OR=1.184,95%CI was 1.032-1.358,P=0.016),sequential organ failure assessment(SOFA:OR=9.717,95%CI was 2.618-36.068,P=0.001),Charson comorbidity index(CCI:OR=4.836,95%CI was 1.860-12.577,P=0.001),hemoglobin(Hb:OR=0.893,95%CI was 0.826-0.966,P=0.005),glutamyltranspeptidase(OR=1.026,95%CI was 1.008-1.045,P=0.006)were independent risk factors for sepsis in ICU patients.Pulmonary infection(OR=28.795,95%CI was 3.296-251.553,P=0.002),APACHEⅡscore(OR=1.273,95%CI was 1.104-1.467,P=0.001),SOFA score(OR=8.670,95%CI was 2.330-32.261,P=0.001),CCI(OR=5.141,95%CI was 1.961-13.475,P=0.001),Hb(OR=0.922,95%CI was 0.857-0.993,P=0.031),glutamyltranspeptidase(OR=1.020,95%CI was 1.002-1.038,P=0.030)were independent risk factors for SAE in sepsis patients.ROC curve analysis showed that the area under the curve(AUC)of pulmonary infection,APACHEⅡscore,SOFA score,CCI,Hb,and glutamyltranspeptidase for predicting sepsis were 0.792,0.728,0.987,0.933,0.720,and 0.699,respectively;the AUC of the combined prediction of the above 6 variables for sepsis was 1.000,with a sensitivity of 100%and a specificity of 100%.The AUC predicted by pulmonary infection,APACHEⅡscore,SOFA score,CCI,and Hb for SAE were 0.776,0.810,0.907,0.917,and 0.758,respectively;the AUC of the combined prediction of the above 5 variables for SAE was 0.975,with a sensitivity of 97.3%and a specificity of 93.1%.Conclusions Sepsis is more severe when accompanied by encephalopathy.Pulmonary infection,Hb,APACHEⅡscore,SOFA score and CCI were independent risk factors of SAE.The combination of the above five indicators has good predictive value for early screening and prevention of the disease.