开发和验证一种评分系统以预测 ICU 脓毒症患者的死亡率：一项多中心回顾性研究。
Development and validation of a score to predict mortality in ICU patients with sepsis: a multicenter retrospective study.
机构信息
Department of General Practice, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China.
Department of Emergency Intensive Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China.
出版信息
J Transl Med. 2021 Jul 29;19(1):322. doi: 10.1186/s12967-021-03005-y.
BACKGROUND
Early and accurate identification of septic patients at high risk for ICU mortality can help clinicians make optimal clinical decisions and improve the patients' outcomes. This study aimed to develop and validate (internally and externally) a mortality prediction score for sepsis following admission in the ICU.
METHODS
We extracted data retrospectively regarding adult septic patients from one teaching hospital in Wenzhou, China and a large multi-center critical care database from the USA. Demographic data, vital signs, laboratory values, comorbidities, and clinical outcomes were collected. The primary outcome was ICU mortality. Through multivariable logistic regression, a mortality prediction score for sepsis was developed and validated.
RESULTS
Four thousand two hundred and thirty six patients in the development cohort and 8359 patients in three validation cohorts. The Prediction of Sepsis Mortality in ICU (POSMI) score included age ≥ 50 years, temperature < 37 °C, Respiratory rate > 35 breaths/min, MAP ≤ 50 mmHg, SpO2 < 90%, albumin ≤ 2 g/dL, bilirubin ≥ 0.8 mg/dL, lactate ≥ 4.2 mmol/L, BUN ≥ 21 mg/dL, mechanical ventilation, hepatic failure and metastatic cancer. In addition, the area under the receiver operating characteristic curve (AUC) for the development cohort was 0.831 (95% CI, 0.813-0.850) while the AUCs ranged from 0.798 to 0.829 in the three validation cohorts. Moreover, the POSMI score had a higher AUC than both the SOFA and APACHE IV scores. Notably, the Hosmer-Lemeshow (H-L) goodness-of-fit test results and calibration curves suggested good calibration in the development and validation cohorts. Additionally, the POSMI score still exhibited excellent discrimination and calibration following sensitivity analysis. With regard to clinical usefulness, the decision curve analysis (DCA) of POSMI showed a higher net benefit than SOFA and APACHE IV in the development cohort.
CONCLUSION
POSMI was validated to be an effective tool for predicting mortality in ICU patients with sepsis.
背景
早期准确识别 ICU 高死亡率的脓毒症患者有助于临床医生做出最佳临床决策并改善患者预后。本研究旨在开发和验证（内部和外部）一种 ICU 入住后脓毒症死亡率预测评分。
方法
我们回顾性地从中国温州的一家教学医院和美国的一个大型多中心重症监护数据库中提取了有关成年脓毒症患者的数据。收集了人口统计学数据、生命体征、实验室值、合并症和临床结局。主要结局是 ICU 死亡率。通过多变量逻辑回归，开发并验证了一种脓毒症死亡率预测评分。
结果
在开发队列中纳入了 4236 例患者，在三个验证队列中纳入了 8359 例患者。预测 ICU 脓毒症死亡率（POSMI）评分包括年龄≥50 岁、体温<37°C、呼吸频率>35 次/分、平均动脉压≤50mmHg、SpO2<90%、白蛋白≤2g/dL、胆红素≥0.8mg/dL、乳酸≥4.2mmol/L、BUN≥21mg/dL、机械通气、肝衰竭和转移性癌症。此外，开发队列的受试者工作特征曲线下面积（AUC）为 0.831（95%CI，0.813-0.850），而三个验证队列的 AUC 范围为 0.798 至 0.829。此外，POSMI 评分的 AUC 高于 SOFA 和 APACHE IV 评分。值得注意的是，Hosmer-Lemeshow（H-L）拟合优度检验结果和校准曲线表明开发和验证队列中具有良好的校准。此外，POSMI 评分在敏感性分析后仍表现出良好的区分度和校准度。关于临床实用性，POSMI 的决策曲线分析（DCA）在开发队列中显示出比 SOFA 和 APACHE IV 更高的净获益。
结论
POSMI 被验证为一种预测 ICU 脓毒症患者死亡率的有效工具。
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