Xue Gaici, Liang Hongyi, Ye Jiasheng, Ji Jingjing, Chen Jianyu, Ji Bo, Liu Zhifeng
Department of Neurosurgery, General Hospital of Southern Theatre Command of People's Liberation Army of China (PLA), Guangzhou, China.
Department of Clinical Pharmacy, General Hospital of Southern Theatre Command of People's Liberation Army of China (PLA), Guangzhou, China.
Front Med (Lausanne). 2021 Nov 12;8:741914. doi: 10.3389/fmed.2021.741914. eCollection 2021.
To develop and validate a scoring system to predict the risk of in-hospital death in patients with intra-abdominal infection (IAI). Patients with IAI ( = 417) treated at our hospital between June 2010 and May 2020 were retrospectively reviewed. Risk factors for in-hospital death were identified by logistic regression analysis. The regression coefficients of each risk factor were re-assigned using the mathematical transformation principle to establish a convenient predictive scoring system. The scoring system was internally validated by bootstrapping sample method. Fifty-three (53/417, 12.7%) patients died during hospitalization. On logistic regression analysis, high APACHE II score ( = 0.012), pneumonia ( = 0.002), abdominal surgery ( = 0.001), hypoproteinemia ( = 0.025), and chronic renal insufficiency ( = 0.001) were independent risk factors for in-hospital death. On receiver operating characteristic curve analysis, the composite index combining these five risk factors showed a 62.3% sensitivity and 80.2% specificity for predicting in-hospital death (area under the curve: 0.778; 95% confidence interval: 0.711-0.845, < 0.001). The predictive ability of the composite index was better than that of each independent risk factor. A scoring system (0-14 points) was established by re-assigning each risk factor based on the logistic regression coefficient: APACHE II score (10-15 score, 1 point; >15 score, 4 points); pneumonia (2 points), abdominal surgery (2 points), hypoproteinemia (2 points), and chronic renal insufficiency (4 points). Internal validation by 1,000 bootstrapping sample showed relatively high discriminative ability of the scoring system (C-index = 0.756, 95% confidence interval: 0.753-0.758). The predictive scoring system based on APACHE II score, pneumonia, abdominal surgery, hypoproteinemia, and chronic renal insufficiency can help predict the risk of in-hospital death in patients with IAI.
开发并验证一种评分系统，以预测腹腔内感染（IAI）患者的院内死亡风险。对2010年6月至2020年5月期间在我院接受治疗的IAI患者（n = 417）进行回顾性分析。通过逻辑回归分析确定院内死亡的危险因素。利用数学变换原理重新分配各危险因素的回归系数，建立简便的预测评分系统。采用自抽样法对评分系统进行内部验证。53例（53/417，12.7%）患者在住院期间死亡。逻辑回归分析显示，高APACHE II评分（P = 0.012）、肺炎（P = 0.002）、腹部手术（P = 0.001）、低蛋白血症（P = 0.025）和慢性肾功能不全（P = 0.001）是院内死亡的独立危险因素。在受试者工作特征曲线分析中，结合这五个危险因素的综合指数预测院内死亡的灵敏度为62.3%，特异度为80.2%（曲线下面积：0.778；95%置信区间：0.711 - 0.845，P < 0.001）。综合指数的预测能力优于各独立危险因素。根据逻辑回归系数重新分配各危险因素，建立了一个评分系统（0 - 14分）：APACHE II评分（10 - 15分，1分；>15分，4分）；肺炎（2分）、腹部手术（2分）、低蛋白血症（2分）和慢性肾功能不全（4分）。通过1000次自抽样进行内部验证，结果显示该评分系统具有较高的鉴别能力（C指数 = 0.756，95%置信区间：0.753 - 0.758）。基于APACHE II评分、肺炎、腹部手术、低蛋白血症和慢性肾功能不全的预测评分系统有助于预测IAI患者的院内死亡风险。
