摘要
目的探究脓毒症心功能障碍(sepsis-induced myocardial dysfunction,SIMD)患者中西医结合预后临床预测模型的构建,以及对模型做出验证。方法研究采用单中心、回顾性研究方法,选择2016年6月-2022年1月黑龙江中医药大学附属第二医院符合研究标准的住院SIMD患者作为队列人群,观察住院终点事件发生情况,以28d发生死亡事件的患者作为研究组,未发生死亡事件患者为对照组,回顾性收集SIMD患者的年龄、心率、序贯器官衰竭评估(SOFA)评分、B型尿钠肽(brain natriuretic peptide,BNP)、舌色、舌下脉络、国际标准化比值(international normalized ratio,INR)和肌钙蛋白等原始数据并进行统计分析。结果依据单因素分析确定了8个中西医结合预测变量(年龄、心率、SOFA评分、BNP、舌色、舌下脉络、INR和肌钙蛋白)是发生SIMD的危险因素(P<0.05),多因素Logistic回归分析显示,SOFA评分、BNP和舌下脉络是发生SIMD的独立危险因素。对模型进行内部验证K值为0.635,准确率为0.792。ROC曲线下面积(AUC)为0.801,95%可信区间为0.742~0.862。在最佳阈值为0.561时,模型的敏感度为62.1%,特异度为88.5%,对ROC曲线进行内部验证的结果显示AUC为0.786,敏感度为77.5%,特异度为66.8%。与模型相比,ROC标准差(ROCSD)为0.104,敏感度标准差(sensSD)为0.137,特异度标准差(SpecSD)为0.152。Hosmer-Lemeshow拟合优度检验,显示模型的拟合度良好(χ^(2)=1.055,P=0.587)。校准曲线原始C指数为0.798(95%CI为0.738~0.858),矫正C指数为0.783。结论脓毒症心功能障碍(SIMD)患者中西医结合预后临床预测模型有良好的临床使用度。
Objective To explore the construction of clinical prognostic model for patients with sepsis complicated with cardiac dysfunction(SIMD)combined with traditional Chinese and Western medicine,and to verify the model.Method In this study,a single-center retrospective study was conducted.The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine from June 2016 to January 2022 was selected as the cohort to observe the occurrence of hospitalization endpoint events.The pa-tients who died within 28 days were selected as the study group,and those who did not die were selected as the control group.The original data of SIMD patients was collected retrospectively.Results According to univariate analysis,8 predictors of integrated traditional Chinese and Western medicine[age,heart rate,sequential organ failure assessment(SOFA)score,brain natriuretic peptide(BNP),tongue color,subelingual vein,international normalized ratio(INR)and troponin]were identified as risk factors for SIMD(P<0.05).Multivariate Logistic regression analysis showed that SOFA score,BNP and sublingual vein were independ-ent risk factors for SIMD.The K value of internal verification of the model was 0.635,and the accuracy was 0.792.The area un-der the ROC curve(AUC)was 0.802 and the 95%confidence interval was 0.742 to 0.862.When the optimal threshold was 0.561,the sensitivity of the model was 62.1%and the specificity was 88.5%.The results of internal verification of the ROC curve showed that the AUC was 0.786,the sensitivity was 77.5%and the specificity was 66.8%.Compared with those of the model,the standard deviation of ROC(ROCSD)was 0.104,the standard deviation of sensitivity(sensSD)was 0.137 and the standard deviation of specificity(SpecSD)was 0.152.Hosmer-Lemeshow goodness of fit test showed that the model had a good fit(χ^(2)=1.055,P=0.587).The calibration curve was 0.798 for the original C index(95%CI 0.738 to 0.858)and 0.783 for the corrected C index.Conclusion The prognostic model of integrated traditional Chinese and Western medicine for patients with SIMD has a good clinical application.
作者
李佳卓
梁群
姜芊竹
王鑫
巩菲菲
王兴
LI Jiazhuo;LIANG Qun;JIANG Qianzhu;WANG Xin;GONG Feifei;WANG Xing(Heilongjiang University of Chinese Medicine,Harbin150000,Heilongjiang,China;The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine,Harbin150000,Heilongjiang,China;The First Affiliated Hospital of Heilongjiang University of Chinese Medicine,Harbin150000,Heilongjiang,China)
出处
《中华中医药学刊》
CAS
北大核心
2024年第12期57-61,共5页
Chinese Archives of Traditional Chinese Medicine
基金
国家自然科学基金项目(81974557)
黑龙江省中医药管理局科研项目(ZHY2023-230)
黑龙江省中医药管理局第二批中医临床优秀人才培养项目(黑中医药教发2022-28号)
黑龙江中医药大学科研基金项目(201833)。
关键词
脓毒症
心功能障碍
预测模型
sepsis
cardiac dysfunction
prediction model
