目的 利用Kaiser Permanente败血症风险计算器和实验室指标构建并验证新生儿早发型败血症(EOS)临床预测模型。 方法 回顾性纳入2020年1月至2022年6月于郑州大学第一附属医院新生儿科住院的出生胎龄≥34周的新生儿，收集病例临床资料。基于多因素回归分析筛选预测因子，利用R软件和RStudio软件构建列线图模型。采用Hosmer-Lemeshow检验、受试者工作特征曲线、临床决策曲线(DCA曲线)评价模型。 结果 共纳入769例患儿，包括EOS组107例(其中培养证实5例，临床诊断102例)，非EOS组662例。筛选出胎龄、出生体重、体温、白细胞、C反应蛋白、降钙素原、胎膜早破≥18 h、B族链球菌感染、呼吸机应用、产前应用抗生素10个变量纳入列线图。预测模型表现出良好的区分能力(曲线下面积：0。834，95%CI：0。771～0。896)和一致性。DCA曲线分析表明当阈值概率在6%～95%时，采取相应治疗措施可以得到净收益。 结论 基于Kaiser Permanente败血症风险计算器，结合实验室检查为中国新生儿人群开发并验证了新生儿EOS的临床预测模型，供临床诊疗参考，指导抗生素的使用。 Objective To construct a Chinese neonatal model of early-onset sepsis (EOS) using the Kaiser Permanente sepsis risk calculator and laboratory indicators and validate its clinical prediction potential。 Methods Newborns with a gestational age of ≥34 weeks， who were hospitalized in the Department of Neonatology， the First Affiliated Hospital of Zhengzhou University from January 2020 to June 2022 were retrospectively recruited。Their clinical data were collected。Predictors were screened via the multivariate regression analysis， and the Nomogram model was constructed using R software and RStudio software。Hosmer-Lemeshow test， receiver operating characteristic curve， the decision curve analysis (DCA) were used to evaluate the prediction potential of the Nomogram。 Results A total of 769 patients were enrolled， including 107 patients in the EOS group (5 culture-confirmed cases and 102 clinically diagnosed cases)， and 662 cases in the non-EOS group。Ten variables were screened and introduced into the Nomogram， including the gestational age， birth weight， body temperature， white blood cell count， C-reactive protein， procalcitonin， premature rupture of membranes≥18 h， infection of Group B Streptococcus， ventilator application， and prenatal antibiotics。The predictive model showed good discrimination and consistency， with the area under the curve of 0。834 (95%CI: 0。771-0。896)。 The DCA of the prediction model showed that it was effective in clinical application within the effective threshold of 6%-95%， with a net benefit following the application of corresponding treatment measures。 Conclusions A Chinese neonatal model of EOS was created by using the Kaiser Permanente sepsis risk calculator and laboratory indicators， which has been validated effective。It provides references for clinical management and the guidance for the use of antibiotics。
Establishment of a Chinese neonatal model of early-onset sepsis based on the Kaiser Permanente sepsis risk calculator
Objective To construct a Chinese neonatal model of early-onset sepsis (EOS) using the Kaiser Permanente sepsis risk calculator and laboratory indicators and validate its clinical prediction potential. Methods Newborns with a gestational age of ≥34 weeks, who were hospitalized in the Department of Neonatology, the First Affiliated Hospital of Zhengzhou University from January 2020 to June 2022 were retrospectively recruited.Their clinical data were collected.Predictors were screened via the multivariate regression analysis, and the Nomogram model was constructed using R software and RStudio software.Hosmer-Lemeshow test, receiver operating characteristic curve, the decision curve analysis (DCA) were used to evaluate the prediction potential of the Nomogram. Results A total of 769 patients were enrolled, including 107 patients in the EOS group (5 culture-confirmed cases and 102 clinically diagnosed cases), and 662 cases in the non-EOS group.Ten variables were screened and introduced into the Nomogram, including the gestational age, birth weight, body temperature, white blood cell count, C-reactive protein, procalcitonin, premature rupture of membranes≥18 h, infection of Group B Streptococcus, ventilator application, and prenatal antibiotics.The predictive model showed good discrimination and consistency, with the area under the curve of 0.834 (95%CI: 0.771-0.896). The DCA of the prediction model showed that it was effective in clinical application within the effective threshold of 6%-95%, with a net benefit following the application of corresponding treatment measures. Conclusions A Chinese neonatal model of EOS was created by using the Kaiser Permanente sepsis risk calculator and laboratory indicators, which has been validated effective.It provides references for clinical management and the guidance for the use of antibiotics.
Infant, newbornEarly-onset sepsisSepsis risk calculatorPredictive model
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