{"title":"预测败血症死亡率的全身免疫炎症指数。","authors":"Sridhar Mangalesh, Sharmila Dudani, Ajay Malik","doi":"10.1080/00325481.2022.2140535","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The systemic immune-inflammation index (SII) is a novel parameter and its role in the prognosis of sepsis has never been explored previously.</p><p><strong>Methods: </strong>We retrospectively assessed 267 patients with blood-culture confirmed sepsis. Clinical and laboratory data recorded at intensive care unit (ICU) admission were analyzed. Outcomes of interest included in-hospital mortality and length-of-stay (LOS) in the ICU. Sequential Organ Failure Assessment (SOFA) scores, SII, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were calculated. Multivariable regression analysis was used to identify independent predictors of LOS and mortality. Area under receiver operator characteristic (AUROC) curves were used to determine optimum cutoffs, and the incremental effect of SII on the SOFA score was assessed using model discrimination and calibration properties.</p><p><strong>Results: </strong>There were 76 (28.5%) non-survivors. SII, NLR, and PLR were independent predictors of sepsis mortality, with adjusted odds ratios of 1.51 (1.24-1.84), 1.67 (1.30-2.13) and 1.24 (1.11-1.39). SII and SOFA score were independent predictors of LOS. SII had an AUROC of 0.848, and the optimum cutoff was 564 with a sensitivity and specificity of 85.5% and 71.2%. The addition of SII to the model had a significant incremental effect on the predictive ability of SOFA score (Net Reclassification Index = 0.084, <i>P</i> = 0.025; Integrated Discrimination Index = 0.056, <i>P</i> = 0.001).</p><p><strong>Conclusion: </strong>The SII is an inexpensive parameter that can be used in addition to clinical sepsis scores to improve the accuracy of patient assessment.</p>","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"135 4","pages":"345-351"},"PeriodicalIF":2.6000,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"11","resultStr":"{\"title\":\"The systemic immune-inflammation index in predicting sepsis mortality.\",\"authors\":\"Sridhar Mangalesh, Sharmila Dudani, Ajay Malik\",\"doi\":\"10.1080/00325481.2022.2140535\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The systemic immune-inflammation index (SII) is a novel parameter and its role in the prognosis of sepsis has never been explored previously.</p><p><strong>Methods: </strong>We retrospectively assessed 267 patients with blood-culture confirmed sepsis. Clinical and laboratory data recorded at intensive care unit (ICU) admission were analyzed. Outcomes of interest included in-hospital mortality and length-of-stay (LOS) in the ICU. Sequential Organ Failure Assessment (SOFA) scores, SII, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were calculated. Multivariable regression analysis was used to identify independent predictors of LOS and mortality. Area under receiver operator characteristic (AUROC) curves were used to determine optimum cutoffs, and the incremental effect of SII on the SOFA score was assessed using model discrimination and calibration properties.</p><p><strong>Results: </strong>There were 76 (28.5%) non-survivors. SII, NLR, and PLR were independent predictors of sepsis mortality, with adjusted odds ratios of 1.51 (1.24-1.84), 1.67 (1.30-2.13) and 1.24 (1.11-1.39). SII and SOFA score were independent predictors of LOS. SII had an AUROC of 0.848, and the optimum cutoff was 564 with a sensitivity and specificity of 85.5% and 71.2%. The addition of SII to the model had a significant incremental effect on the predictive ability of SOFA score (Net Reclassification Index = 0.084, <i>P</i> = 0.025; Integrated Discrimination Index = 0.056, <i>P</i> = 0.001).</p><p><strong>Conclusion: </strong>The SII is an inexpensive parameter that can be used in addition to clinical sepsis scores to improve the accuracy of patient assessment.</p>\",\"PeriodicalId\":20329,\"journal\":{\"name\":\"Postgraduate Medicine\",\"volume\":\"135 4\",\"pages\":\"345-351\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2023-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"11\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Postgraduate Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1080/00325481.2022.2140535\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Postgraduate Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/00325481.2022.2140535","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 11
摘要
背景:系统免疫炎症指数(SII)是一个新的参数，其在脓毒症预后中的作用从未被探索过。方法:回顾性分析267例血培养确诊败血症患者。分析重症监护病房(ICU)入院时记录的临床和实验室数据。关注的结局包括住院死亡率和ICU的住院时间(LOS)。计算顺序器官衰竭评估(SOFA)评分、SII、中性粒细胞-淋巴细胞比率(NLR)和血小板-淋巴细胞比率(PLR)。采用多变量回归分析确定LOS和死亡率的独立预测因子。采用接收算子特征曲线下面积(AUROC)确定最佳截止点，并利用模型判别和校准特性评估SII对SOFA评分的增量效应。结果:无幸存者76例(28.5%)。SII、NLR和PLR是脓毒症死亡率的独立预测因子，校正优势比分别为1.51(1.24-1.84)、1.67(1.30-2.13)和1.24(1.11-1.39)。SII和SOFA评分是LOS的独立预测因子。SII的AUROC为0.848，最佳截止值为564，敏感性和特异性分别为85.5%和71.2%。在模型中加入SII对SOFA评分的预测能力有显著的增量效应(Net Reclassification Index = 0.084, P = 0.025;综合歧视指数= 0.056,P = 0.001)。结论:SII是一种廉价的参数，可用于临床脓毒症评分，以提高患者评估的准确性。
The systemic immune-inflammation index in predicting sepsis mortality.
Background: The systemic immune-inflammation index (SII) is a novel parameter and its role in the prognosis of sepsis has never been explored previously.
Methods: We retrospectively assessed 267 patients with blood-culture confirmed sepsis. Clinical and laboratory data recorded at intensive care unit (ICU) admission were analyzed. Outcomes of interest included in-hospital mortality and length-of-stay (LOS) in the ICU. Sequential Organ Failure Assessment (SOFA) scores, SII, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were calculated. Multivariable regression analysis was used to identify independent predictors of LOS and mortality. Area under receiver operator characteristic (AUROC) curves were used to determine optimum cutoffs, and the incremental effect of SII on the SOFA score was assessed using model discrimination and calibration properties.
Results: There were 76 (28.5%) non-survivors. SII, NLR, and PLR were independent predictors of sepsis mortality, with adjusted odds ratios of 1.51 (1.24-1.84), 1.67 (1.30-2.13) and 1.24 (1.11-1.39). SII and SOFA score were independent predictors of LOS. SII had an AUROC of 0.848, and the optimum cutoff was 564 with a sensitivity and specificity of 85.5% and 71.2%. The addition of SII to the model had a significant incremental effect on the predictive ability of SOFA score (Net Reclassification Index = 0.084, P = 0.025; Integrated Discrimination Index = 0.056, P = 0.001).
Conclusion: The SII is an inexpensive parameter that can be used in addition to clinical sepsis scores to improve the accuracy of patient assessment.
期刊介绍：
Postgraduate Medicine is a rapid peer-reviewed medical journal published for physicians. Tracing its roots back to 1916, Postgraduate Medicine was established by Charles Mayo, MD, as a peer-to-peer method of communicating the latest research to aid physicians when making treatment decisions, and it maintains that aim to this day. In addition to its core subscriber base, Postgraduate Medicine is distributed to hundreds of US-based physicians within internal medicine and family practice.
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