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基于NRS评分的老年脓毒症患者预后列线图的建立与验证

Establishment and validation of a prognostic nomogram based on NRS score in elderly patients with sepsis
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摘要 目的:基于营养风险筛查(nutrition risk screening,NRS-2002)评分建立老年脓毒症患者短期死亡率的预后模型。方法:回顾性分析426例老年脓毒症患者的人口学资料、临床资料、NRS-2002评分及生物标志物数据。按7∶3的比例随机分为训练组和验证组,采用Lasso回归对数据进行降维和特征选择。采用多元Cox回归分析预后特征,构建列线图并验证准确性。结果:Lasso回归及多元Cox回归分析显示白蛋白、尿素氮、乳酸、NRS-2002评分是影响老年脓毒症患者30 d内预后的独立危险因素(P<0.05)。列线图结果提示训练组和验证组的受试者工作特征曲线下面积分别为0.772(95%CI:0.734~0.812)和0.730(95%CI:0.695~0.766),2组标定曲线拟合良好。结论:构建基于NRS评分的老年脓毒症患者预后列线图,可以帮助临床医生及时评估该类患者的早期死亡风险,并采取相应的积极措施。 Objective:To determine the prognostic factors in elderly patients with sepsis and to establish a prognostic model for predicting short-term mortality based on nutrition risk screening scores(NRS-2002).Methods:Demographic details,clinical information,data on biological marker of 426 elderly patients with sepsis were collected and NRS-2002 score were calculated within the first 24 hours of hospital admission.In a 7∶3 ratio,these patients were randomly divided into the training group and the validation group.The Lasso regression model was used to reduce data dimensions and select features.Cox regression analysis was conducted to analyze prognostic signature,based on which a nomogram was developed,and its predictive accuracy was evaluated.Results:Lasso regression analysis and multiple Cox regression analysis showed that albumin,urea nitrogen,lactic acid,and NRS-2002 score were independent risk factors that affected the 30-day prognosis of elderly patients with sepsis(P<0.05).The areas under the receiver operating characteristic curves of the nomogram in the training and validation groups were 0.772(95%CI:0.734-0.812)and 0.730(95%CI:0.695-0.766),respectively.The calibration curves were fitted well in the two groups.Conclusion:The construction of prognostic nomogram based on NRS score can help clinicians timely assess the early risk of death in elderly patients with sepsis and accordingly take proactive measures.
作者 李芳 周卫凤 潘敏 王书 LI Fang;ZHOU Weifeng;PAN Min;WANG Shu(Department of Clinical Medicine,Anhui Medical College,Hefei 230601,China;Department of Geriatrics,The Third Affiliated Hospital of Anhui Medical University(Binhu Hospital of Hefei))
出处 《沈阳医学院学报》 2024年第6期589-596,共8页 Journal of Shenyang Medical College
基金 安徽省教育厅自然科学研究重点项目(No.2022AH052334)。
关键词 老年患者 脓毒症 生物标志物 营养风险筛查 预测模型 elderly patients sepsis biomarkers nutritional risk screening prediction model
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