Establish and validate the prognosis model of sepsis patients by ultra-early vital signs and lactate level

doi:10.3877/cma.j.issn.2095-5820.2020.03.004

Abstract

Abstract:

Objective

To establish and validate a nomogram scoring system to evaluate the severity of the sepsis patient.

Methods

Clinical application scenarios clinical data available within 1 hour of admission to the ICU was used to establish the nomogram scoring system. Clinical predictors included age, sex, vital signs, vasopressor use and lactate level within 1 hour. 30-day mortality as an outcome. Logistic regression analysis model was used to determine independent risk factors and a nomogram was established to predict 30-day mortality.The validation was performed using repeated sampling method.

Results

A nomogram of 30-day mortality was established in sepsis patients with a C-index of 0.759 (95% CI: 0.725~0.794) and a validated discriminant C-index of 0.762 (95% CI: 0.728~0.797) using repeated sampling methods.

Conclusion

Nomogram model will clinically be relevant for ultra-early determination of prognosis and severity of sepsis and has clinical significance. However, this model needs to be further validated.

Key words: Sepsis, Prognostic model, Vital signs, Lactate

Qilin Yang, Wendi Liang, Fuhua Xie, Zhenghui Zhang, Xuming Xiong, Weiyan Chen. Establish and validate the prognosis model of sepsis patients by ultra-early vital signs and lactate level[J]. Chinese Journal of Clinical Laboratory Management(Electronic Edition), 2020, 08(03): 145-149.

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Figures/Tables 5

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特征	总人群(1721人)	存活组(1333人)	死亡组(388人)	T值或卡方值	P值
年龄(岁)	65±17	64±17	70±16	-7.854	<0.001
性别(男%)	965(56.07%)	753(56.49%)	212(54.64%)	0.684	0.518
心率(次/分)	111.95±22.10	110.08±21.36	118.37±23.39	-3.763	<0.001
收缩压(mmHg)	84.19±17.41	86.50±15.65	76.32±20.56	2.908	<0.001
呼吸频率(次/分)	29.03±6.95	28.42±6.56	31.09±7.83	-4.373	<0.001
体温(℃)	37.72±0.93	37.77±0.86	37.55±1.11	2.753	<0.001
血氧饱和度(%)	89.21±12.17	90.71±9.30	84.03±18.09	5.928	<0.001
乳酸(mmol/L)	2.30(1.40-3.70)	2.10(1.40-3.40)	3.00(1.80-5.70)	-1.642	<0.001
使用血管活性药(%)	687(39.92%)	465(34.88%)	222(57.22%)	59.654	<0.001

特征	总人群(1721人)	存活组(1333人)	死亡组(388人)	T值或卡方值	P值
年龄(岁)	65±17	64±17	70±16	-7.854	<0.001
性别(男%)	965(56.07%)	753(56.49%)	212(54.64%)	0.684	0.518
心率(次/分)	111.95±22.10	110.08±21.36	118.37±23.39	-3.763	<0.001
收缩压(mmHg)	84.19±17.41	86.50±15.65	76.32±20.56	2.908	<0.001
呼吸频率(次/分)	29.03±6.95	28.42±6.56	31.09±7.83	-4.373	<0.001
体温(℃)	37.72±0.93	37.77±0.86	37.55±1.11	2.753	<0.001
血氧饱和度(%)	89.21±12.17	90.71±9.30	84.03±18.09	5.928	<0.001
乳酸(mmol/L)	2.30(1.40-3.70)	2.10(1.40-3.40)	3.00(1.80-5.70)	-1.642	<0.001
使用血管活性药(%)	687(39.92%)	465(34.88%)	222(57.22%)	59.654	<0.001

变量	单因素Logistic回归		多因素Logistic回归
变量	OR (95%CI)	P值	OR (95%CI)	P值
年龄(岁)	1.01 (1.00, 1.02)	0.0078	1.01 (1.00, 1.02)	0.0428
性别(男%)	0.92 (0.72, 1.18)	0.5222	?	?
心率(次/分)	1.02 (1.02, 1.03)	<0.0001	1.01 (1.01, 1.02)	0.0001
收缩压(mmHg)	0.96 (0.95, 0.96)	<0.0001	0.98 (0.97, 0.99)	<0.0001
呼吸频率(次/分)	1.06 (1.04, 1.08)	<0.0001	1.07 (1.04, 1.09)	<0.0001
体温(℃)	0.82 (0.71, 0.94)	0.0045	0.72 (0.61, 0.84)	<0.0001
血氧饱和度	0.95 (0.94, 0.96)	<0.0001	0.97 (0.96, 0.98)	<0.0001
乳酸(mmol/L)	1.26 (0.72,1.32)	<0.0001	1.16 (1.10,1.23)	<0.0001
使用血管活性药物(%)	3.66 (2.81, 4.77)	<0.0001	2.10 (1.53, 2.87)	<0.0001

变量	单因素Logistic回归		多因素Logistic回归
变量	OR (95%CI)	P值	OR (95%CI)	P值
年龄(岁)	1.01 (1.00, 1.02)	0.0078	1.01 (1.00, 1.02)	0.0428
性别(男%)	0.92 (0.72, 1.18)	0.5222	?	?
心率(次/分)	1.02 (1.02, 1.03)	<0.0001	1.01 (1.01, 1.02)	0.0001
收缩压(mmHg)	0.96 (0.95, 0.96)	<0.0001	0.98 (0.97, 0.99)	<0.0001
呼吸频率(次/分)	1.06 (1.04, 1.08)	<0.0001	1.07 (1.04, 1.09)	<0.0001
体温(℃)	0.82 (0.71, 0.94)	0.0045	0.72 (0.61, 0.84)	<0.0001
血氧饱和度	0.95 (0.94, 0.96)	<0.0001	0.97 (0.96, 0.98)	<0.0001
乳酸(mmol/L)	1.26 (0.72,1.32)	<0.0001	1.16 (1.10,1.23)	<0.0001
使用血管活性药物(%)	3.66 (2.81, 4.77)	<0.0001	2.10 (1.53, 2.87)	<0.0001

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