Development and validation of predictive model for 28-day mortality in very older patients with sepsis
Objective To develop and validate a predictive nomogram for 28-day mortality among very older patients with sepsis,to identify high-risk patients early and improve prognosis.Methods This study was conducted from January 1,2022,to November 30,2022.Very older patients aged≥80 years with sepsis admitted to the emergency department of Beijing Chao-Yang Hospital,Capital Medical University were consecutively recruited.Their clinical data within 24 h of admission and 28-day mortality was recorded.The participants were divided into training(70％)and validation cohort(30％)(random number).In the training cohort,the risk factors of 28-day mortality were selected via least absolute shrinkage and selection operator(LASSO)regression analysis and multivariable Cox proportional hazard model,and a nomogram was developed.The prediction model was verified in validation cohort.Results In total,507 very older patients with sepsis were included,among which the mortality rate was 31.2％.In training cohort,the independent risk factors for 28-day mortality were identified:increased age[hazard ratio(HR)=1.059,95％confidence interval(95％CI)=1.017-1.103,P=0.005],cognitive impairment(HR=2.100,95％CI=1.322-3.336,P=0.002),frailty(HR=2.561,95％CI=1.183-5.545,P=0.017),decreased mean arterial pressure(HR=0.987,95％CI=0.976-0.998,P=0.017),decreased prealbumin(HR=0.997,95％CI=0.994-1.000,P=0.040),increased blood urea nitrogen(HR=1.028,95％CI=1.010-1.045,P=0.001),increased procalcitonin(HR=1.008,95％CI=1.001-1.016,P=0.019)via LASSO regression analysis and multivariable Cox regression analysis.The nomogram was developed using these seven predictors.In the training and validation cohorts,the calibration curves,time-dependent AUC curves,and decision curve analysis showed that the nomogram had good calibration degree,discrimination and clinical net benefits.Conclusions Increased age,cognitive impairment,frailty,decreased mean arterial pressure,decreased prealbumin,increased blood urea nitrogen,and increased procalcitonin are independent risk factors for 28-day mortality in very older patients with sepsis.The nomogram,which included the seven predictors,have good predictive performance,and might be helpful for prognosis assessment.
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