APACHEⅡ评分、IL-6与T淋巴细胞亚群联合构建脓毒症病情严重程度的预测模型

Construction of a predictive model for the severity of sepsis based on APACHEⅡscore,IL-6,and T lymphocyte subsets

目的急性生理学和慢性健康状况评分(APACHEⅡ评分)、白介素-6(IL-6)与T淋巴细胞亚群联合构建脓毒症病情严重程度的预测模型,并评价模型的效能。方法选取2021年1月至2023年9月安庆市立医院收治的脓毒症患者225例为研究对象,测定确诊后24 h内IL-6、T淋巴细胞亚群(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、C-反应蛋白(CRP)、降钙素原(PCT)和APACHEⅡ评分;依据Sepsis-3.0诊断标准将其分为脓毒症组(109例)和脓毒性休克组(116例),根据logistic回归分析选择变量并构建脓毒症病情严重程度的预测模型,采用校准图和决策曲线分析评价模型的拟合度和临床价值。结果脓毒性休克组CD4^(+)、CD4^(+)/CD8^(+)水平低于脓毒症组,CPR、PCT、IL-6、APACHEⅡ评分高于脓毒症组(P<0.05);构建的脓毒症严重程度预测模型为:ln[P/(1-P)]=0.999+0.054×APACHEⅡ评分-0.054×CD4^(+)-0.18×CD4^(+)/CD8^(+)+0.001×IL-6。校准图和决策曲线图表明模型具有良好的拟合度和临床价值。结论由CD4^(+)、CD4^(+)/CD8^(+)、IL-6和APACHEⅡ评分构建的预测模型可用于早期评估脓毒症病情的严重程度,为临床诊断及治疗提供帮助。

Objective To construct a predictive model for the severity of sepsis using the Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,interleukin-6(IL-6),and T lymphocyte subsets,and to evaluate the model's effectiveness.Methods A total of 225 patients with sepsis admitted to the Anqing Municipal Hospital from January 2021 to September 2023 were selected as the study subjects.IL-6,T lymphocyte subsets(CD4^(+),CD8^(+),CD4^(+)/CD8^(+)),C-reactive protein(CRP),procalcitonin(PCT),and APACHEⅡscores were measured within 24 hours after diagnosis.Based on the Sepsis-3.0 diagnostic criteria,patients were divided into the sepsis group(109 cases)and the septic shock group(116 cases).Logistic regression analysis was used to select variables and construct a predictive model for the severity of sepsis.Calibration plots and decision curve analysis were employed to evaluate the model's fit and clinical value.Results The levels of CD4^(+)and CD4^(+)/CD8^(+)in the septic shock group were lower than those in the sepsis group,while CRP,PCT,IL-6,and APACHEⅡscores were higher in the septic shock group than in the sepsis group(P<0.05).The constructed predictive model was as follows:ln[P/(1-P)]=0.999+0.054×APACHEⅡscore-0.054×CD4^(+)-0.18×CD4^(+)/CD8^(+)+0.001×IL-6.Calibration plots and decision curve analyses indicated that the model had good fit and clinical value.Conclusion The predictive model composed of CD4^(+),CD4^(+)/CD8^(+),IL-6,and APACHEⅡscore can be used for early assessment of the severity of sepsis,providing assistance for clinical diagnosis and treatment.