Li Haitao, Fan Shengjin, Lu Dongxue, Zhou Jin
Harbin Medical University, Harbin, 150001, People's Republic of China.
Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China.
Cancer Manag Res. 2023 Sep 29;15:1073-1083. doi: 10.2147/CMAR.S428930. eCollection 2023.
This study aimed to derive and validate a prognostic scoring system to identify patients with hematological malignancies (HMs) and sepsis who have a high mortality rate.
Cohorts for derivation and validation were created from all data. Using univariate and multivariate analysis, the independent variables connected to 28-day mortality in the derivation cohort were found. A receiver operating characteristic (ROC) curve was used to compare the predictive power and determine their cutoff points. These risk variables were given a score weighted by risk prediction function, and a new scoring system was also developed. The area under the ROC curve (AUROC) and sensitivity and specificity for mortality of the risk category of the new scoring system were compared with Sequential Organ Failure Assessment (SOFA) score.
90 (45.22%) of the 199 patients passed away within 28 days. Ninety-nine patients made up the derivation cohort, with 47 (47.47%) fatalities. Ages in the non-survival group were higher (61.47 ± 14.53 vs 55.13 ± 15.66) than in the survival group. As independent predictors of death, multivariable analysis identified SOFA score (OR 1.442, 95% CI 1.035, 2.009), age (OR 1.242, 95% CI 1.026, 1.503), and prothrombin time (PT) (OR 1.213, 95% CI 1.030, 1.430). The AUROC with 95% CI of the new scoring system and its sensitivity and specificity to mortality were virtually all superior to SOFA score in both derivation and validation cohorts: AUROC (0.757 vs 0.716), Sensitivity (75 vs 67.3%), and Specificity (68.1% vs 63.8%) are the Derivation cohort; Validation cohort: Sensitivity (91.2% vs 84.2%), AUROC (0.792 vs 0.733), and Specificity (58.1% vs 58.1%). The model was correctly calibrated, according to the Hosmer-Lemeshow test.
The new scoring system was more accurate in predicting 28-day mortality among patients with HMs and sepsis than the SOFA score.
本研究旨在推导并验证一种预后评分系统，以识别血液系统恶性肿瘤（HMs）合并脓毒症且死亡率较高的患者。
从所有数据中创建推导队列和验证队列。通过单因素和多因素分析，找出推导队列中与28天死亡率相关的独立变量。使用受试者工作特征（ROC）曲线比较预测能力并确定其临界点。根据风险预测函数为这些风险变量赋予分数权重，还开发了一种新的评分系统。将新评分系统风险类别的ROC曲线下面积（AUROC）以及死亡率的敏感性和特异性与序贯器官衰竭评估（SOFA）评分进行比较。
199例患者中有90例（45.22%）在28天内死亡。推导队列由99例患者组成，其中47例（47.47%）死亡。非生存组的年龄高于生存组（61.47±14.53 vs 55.13±15.66）。多因素分析确定SOFA评分（OR 1.442，95%CI 1.035，2.009）、年龄（OR 1.242，95%CI 1.026，1.503）和凝血酶原时间（PT）（OR 1.213，95%CI 1.030，1.430）为死亡的独立预测因素。在推导队列和验证队列中，新评分系统的95%CI的AUROC及其对死亡率的敏感性和特异性几乎均优于SOFA评分：推导队列中，AUROC（0.757 vs 0.716）、敏感性（75% vs 67.3%）和特异性（68.1% vs 63.8%）；验证队列中，敏感性（91.2% vs 84.2%）、AUROC（0.792 vs 0.733）和特异性（58.1% vs 58.1%）。根据Hosmer-Lemeshow检验，模型校准正确。
新评分系统在预测HMs合并脓毒症患者的28天死亡率方面比SOFA评分更准确。
