Xu Fengshuo, Zhang Luming, Huang Tao, Han Didi, Yang Rui, Zheng Shuai, Feng Aozi, Huang Liying, Yin Haiyan, Lyu Jun
Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China.
Department of Nosocomial Infection Management, Luoyang Orthopedic-Traumatological Hospital, Orthopedics Hospital of Henan Province, Zhengzhou, China.
Front Med (Lausanne). 2022 Aug 22;9:898424. doi: 10.3389/fmed.2022.898424. eCollection 2022.
Sepsis is a serious disease with high clinical morbidity and mortality. Despite the tremendous advances in medicine and nursing, treatment of sepsis remains a huge challenge. Our purpose was to explore the effects of shock index (SI) trajectory changes on the prognosis of patients within 24 h after the diagnosis of sepsis.
This study was based on Medical Information Mart for Intensive Care IV (MIMIC- IV). The effects of SI on the prognosis of patients with sepsis were investigated using C-index and restricted cubic spline (RCS). The trajectory of SI in 24 h after sepsis diagnosis was classified by latent growth mixture modeling (LGMM). Cox proportional hazard model, double robust analysis, and subgroup analysis were conducted to investigate the influence of SI trajectory on in-hospital death and secondary outcomes.
A total of 19,869 patients were eventually enrolled in this study. C-index showed that SI had a prognostic value independent of Sequential Organ Failure Assessment for patients with sepsis. Moreover, the results of RCS showed that SI was a prognostic risk factor. LGMM divided SI trajectory into seven classes, and patients with sepsis in different classes had notable differences in prognosis. Compared with the SI continuously at a low level of 0.6, the SI continued to be at a level higher than 1.0, and the patients in the class whose initial SI was at a high level of 1.2 and then declined had a worse prognosis. Furthermore, the trajectory of SI had a higher prognostic value than the initial SI.
Both initial SI and trajectory of SI were found to be independent factors that affect the prognosis of patients with sepsis. Therefore, in clinical treatment, we should closely monitor the basic vital signs of patients and arrive at appropriate clinical decisions on basis of their change trajectory.
脓毒症是一种临床发病率和死亡率都很高的严重疾病。尽管医学和护理领域取得了巨大进展，但脓毒症的治疗仍然是一项巨大挑战。我们的目的是探讨休克指数（SI）轨迹变化对脓毒症诊断后24小时内患者预后的影响。
本研究基于重症监护医学信息集市IV（MIMIC-IV）。使用C指数和受限立方样条（RCS）研究SI对脓毒症患者预后的影响。通过潜在增长混合模型（LGMM）对脓毒症诊断后24小时内的SI轨迹进行分类。采用Cox比例风险模型、双重稳健分析和亚组分析来研究SI轨迹对院内死亡和次要结局的影响。
本研究最终纳入19869例患者。C指数表明，SI对脓毒症患者具有独立于序贯器官衰竭评估的预后价值。此外，RCS结果表明SI是一个预后危险因素。LGMM将SI轨迹分为七类，不同类别脓毒症患者的预后存在显著差异。与SI持续处于0.6的低水平相比，SI持续处于高于1.0的水平，以及初始SI处于1.2的高水平然后下降的类别中的患者预后更差。此外，SI轨迹的预后价值高于初始SI。
初始SI和SI轨迹均被发现是影响脓毒症患者预后的独立因素。因此，在临床治疗中，我们应密切监测患者的基本生命体征，并根据其变化轨迹做出适当的临床决策。
