开发和验证用于预测 PICU 败血症患者败血症相关脑病风险的提名图:一项多中心回顾性队列研究。

IF 3.8 2区 医学 Q1 CRITICAL CARE MEDICINE
Guan Wang, Xinzhu Jiang, Yanan Fu, Yan Gao, Qin Jiang, Enyu Guo, Haoyang Huang, Xinjie Liu
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引用次数: 0

摘要

背景:脓毒症相关脑病(SAE)患者的死亡率较高,入住重症监护室的时间较长。SAE 的预测因素尚未确定。我们的目的是为儿科重症监护病房(PICU)收治的脓毒症患者建立一个有效且简单易用的SAE个体预测提名图,以预防SAE的早期发生:在这项回顾性多中心研究中,我们对中国山东三家医院儿科重症监护室(PICU)收治的 790 名败血症患者进行了筛查。在训练队列中使用最小绝对收缩和选择算子回归进行变量选择和正则化。所选变量被用于构建一个预测 PICU 败血症患者 SAE 风险的提名图。结果:2017年1月至2022年5月,来自三个中心的613名脓毒症患者符合纳入最终研究的条件。训练队列由 251 名患者组成,两个独立的验证队列分别由 193 名和 169 名患者组成。共有 237 名(38.7%)患者出现 SAE。脓毒症患者 SAE 的发病率与呼吸频率、血尿素氮、活化部分凝血活酶时间、动脉二氧化碳分压和儿科危重病评分有关。我们在训练队列(曲线下面积 [AUC] 0.82,95% 置信区间 [CI] 0.76-0.88,灵敏度 65.6%,特异度 88.8%)和验证队列(验证队列 1:AUC 0.80,95% CI 0.74-0.86,灵敏度 75.0%,特异度 74.3%;验证队列 2:AUC 0.81,95% CI 0.73-0.88,灵敏度 69.1%,特异度 83.3%)。提名图的校准图显示,观察值和预测值的 SAE 概率非常一致。决策曲线分析表明,提名图具有很高的临床净效益:新型提名图和在线计算器在预测 PICU 败血症患者 SAE 的发病率方面表现出色,从而为临床医生早期发现和干预 SAE 提供了潜在帮助。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Development and validation of a nomogram to predict the risk of sepsis-associated encephalopathy for septic patients in PICU: a multicenter retrospective cohort study.

Background: Patients with sepsis-associated encephalopathy (SAE) have higher mortality rates and longer ICU stays. Predictors of SAE are yet to be identified. We aimed to establish an effective and simple-to-use nomogram for the individual prediction of SAE in patients with sepsis admitted to pediatric intensive care unit (PICU) in order to prevent early onset of SAE.

Methods: In this retrospective multicenter study, we screened 790 patients with sepsis admitted to the PICU of three hospitals in Shandong, China. Least absolute shrinkage and selection operator regression was used for variable selection and regularization in the training cohort. The selected variables were used to construct a nomogram to predict the risk of SAE in patients with sepsis in the PICU. The nomogram performance was assessed using discrimination and calibration.

Results: From January 2017 to May 2022, 613 patients with sepsis from three centers were eligible for inclusion in the final study. The training cohort consisted of 251 patients, and the two independent validation cohorts consisted of 193 and 169 patients. Overall, 237 (38.7%) patients developed SAE. The morbidity of SAE in patients with sepsis is associated with the respiratory rate, blood urea nitrogen, activated partial thromboplastin time, arterial partial pressure of carbon dioxide, and pediatric critical illness score. We generated a nomogram for the early identification of SAE in the training cohort (area under curve [AUC] 0.82, 95% confidence interval [CI] 0.76-0.88, sensitivity 65.6%, specificity 88.8%) and validation cohort (validation cohort 1: AUC 0.80, 95% CI 0.74-0.86, sensitivity 75.0%, specificity 74.3%; validation cohort 2: AUC 0.81, 95% CI 0.73-0.88, sensitivity 69.1%, specificity 83.3%). Calibration plots for the nomogram showed excellent agreement between SAE probabilities of the observed and predicted values. Decision curve analysis indicated that the nomogram conferred a high net clinical benefit.

Conclusions: The novel nomogram and online calculator showed performance in predicting the morbidity of SAE in patients with sepsis admitted to the PICU, thereby potentially assisting clinicians in the early detection and intervention of SAE.

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来源期刊
Journal of Intensive Care
Journal of Intensive Care Medicine-Critical Care and Intensive Care Medicine
CiteScore
11.90
自引率
1.40%
发文量
51
审稿时长
15 weeks
期刊介绍: "Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction. Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.
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