Prognostic predictors in patients with sepsis after gastrointestinal tumor surgery:A retrospective study

BACKGROUND There have been different reports on mortality of sepsis;however,few focus on the prognosis of patients with sepsis after surgery.AIM To study the clinical features and prognostic predictors in patients with sepsis after gastrointestinal tumor surgery in intensive care unit(ICU).METHODS We retrospectively screened patients who underwent gastrointestinal tumor surgery at Peking University Cancer Hospital from January 2015 to December 2019.Among them,181 patients who were diagnosed with sepsis in ICU were included in our study.Survival was analysed by the Kaplan-Meier method.Univariate and multivariate adjusted analyses were performed to identify predictors of prognosis.RESULTS The 90-d all-cause mortality rate was 11.1%in our study.Univariate analysis showed that body mass index(BMI),shock within 48 h after ICU admission,leukocyte count,lymphocyte to neutrophil ratio,international normalized ratio,creatinine,procalcitonin,lactic acid,oxygenation index,and sequential organ failure assessment(SOFA)score within 24 h after ICU admission might be all significantly associated with the prognosis of sepsis after gastrointestinal tumor surgery.In multiple analysis,we found that BMI≤20 kg/m^(2),lactic acid after ICU admission,and SOFA score within 24 h after ICU admission might be independent risk predictors of the prognosis of sepsis after gastrointestinal tumor surgery.Compared with SOFA score,SOFA score combined with BMI and lactic acid might have higher predictive ability(area under the receiver operating characteristic curve,0.859;95%confidence interval,0.789-0.929).CONCLUSION Lactic acid and SOFA score within 24 h after ICU admission are independent risk predictors of the prognosis of sepsis after gastrointestinal tumor surgery.SOFA score combined with BMI and lactic acid might have good predictive value.

Nomogram for predicting the prognosis of tumor patients with sepsis after gastrointestinal surgery

BACKGROUND There were few studies on the prognosis of tumor patients with sepsis after gastrointestinal surgery and there was no relevant nomogram for predicting the prognosis of these patients.AIM To establish a nomogram for predicting the prognosis of tumor patients with sepsis after gastrointestinal surgery in the intensive care unit(ICU).METHODS A total of 303 septic patients after gastrointestinal tumor surgery admitted to the ICU at Peking University Cancer Hospital from January 1, 2013 to December 31, 2020 were analysed retrospectively. The model for predicting the prognosis of septic patients was established by the R software package.RESULTS The most common infection site of sepsis after gastrointestinal surgery in the ICU was abdominal infection. The 90-d all-cause mortality rate was 10.2% in our study group. In multiple analyses, we found that there were statistically significant differences in tumor type, septic shock, the number of lymphocytes after ICU admission, serum creatinine and total operation times among tumor patients with sepsis after gastrointestinal surgery(P < 0.05). These five variables could be used to establish a nomogram for predicting the prognosis of these septic patients. The nomogram was verified, and the initial C-index was 0.861. After 1000 internal validations of the model, the C-index was 0.876, and the discrimination was good. The correction curve indicated that the actual value was in good agreement with the predicted value.CONCLUSION The nomogram based on these five factors(tumor type, septic shock, number of lymphocytes, serum creatinine, and total operation times) could accurately predict the prognosis of tumor patients with sepsis after gastrointestinal surgery.