目的 探讨重症监护病房(intensive care medcine,ICU)内急性胰腺炎患者(acute pancreatitis,AP)发生脓毒症的危险因素,构建列线图(nomogram)模型并进行评价.方法 回顾性分析2013年10月至2023年10月在安徽医科大学第二附属医院重症医学一科收治的306例AP患者的临床资料,根据是否发生脓毒症分为脓毒症组和非脓毒症组.比较两组患者基线资料以及实验室检查指标,将研究对象随机(随机数字法)分为训练集和验证集,采用最小绝对收缩与选择算子(least absolute shrinkage and selection operator,LASSO)回归筛选出最优变量,然后进行多因素Logistic回归分析并构建Nomogram图风险预测模型,再对模型进行预测效能进行评估.结果 共纳入306例AP患者,其中,发生脓毒症患者127例,未发生脓毒症患者179例.按照7:3的比例随机分为训练集215例和验证集91例.多因素logistic回归分析发现,BM1、APACHE Ⅱ评分、血小板,IL-6、总胆红素和并发症是AP患者发生脓毒症的独立危险因素,据此构建Nomogram图风险预测模型;训练集和验证集的模型ROC曲线下面积分别是0.913(95％CI:0.875～0.951)和0.901(95％CI 0.837～0.965);校准曲线显示预测概率与实际概率基本一致.决策曲线分析显示其在较大的阈值范围内具有良好的临床净收益.结论 ICU内AP并发脓毒症的独立危险因素为BMI、APACHE Ⅱ评分、血小板,IL-6、总胆红素和并发症,据此建立的Nomogram图风险预测模型具有较高的预测价值.
Risk factors for acute pancreatitis complicated with sepsis in intensive care unit
Objective To study the risk factors for sepsis with acute pancreatitis(AP)in the intensive care unit,Nomogram models were constructed and evaluatedand.Methods Clinical data of 306 AP patients were admitted to the First Department of Critical Care Medicine.The Second Affiliated Hospital of Anhui Medical University from October 2013 to October 2023 were included,they were divided into sepsis group and non-sepsis group according to whether sepsis occurred.Baseline data and laboratory test results of the two groups were compared.The study subjects were randomly(random number)divided into training set and verification set,and the optimal variables were selected by LASSO regression.Then multivariate Logistic regression analysis was performed to construct a Nomogram risk prediction model.Then the prediction efficiency of the model was evaluated.Results A total of 306 AP patients were included,including 127 patients with sepsis and 179 patients without sepsis.According to the ratio of 7∶3,215 cases were randomly(random number)divided into the training set and 91 cases were verified.Multivariate Logistic regression analysis showed that BMI,APACHE Ⅱ score,platelet,IL-6,total bilirubin and complications were independent risk factors for sepsis in patients with AP.According to the above risk factors,a Nomogram prediction model was established.The area under ROC curve of the model in training set and verified set were 0.913(95％CI0.875-0.951)and 0.901(95％CI 0.837-0.965)respectively.The calibration curve shows that the predicted probability is basically consistent with the actual probability.Decision curve analysis shows that it has good clinical net benefit in a large threshold range.Conclusions The independent risk factors of AP associated with sepsis in ICU are BMI,APACHE Ⅱ score,platelet,IL-6,total bilirubin and complications.The Nomogram risk predictive model based on these factors has good predictive power.
Intensive care unitAcute pancreatitisSepsisRisk factorPredictive model
万方数据
维普
