Department of Pediatric Surgery, Women and Children's Hospital Affiliated to Ningbo University, Ningbo, Zhejiang, China.
Department of School of Foundation, Zhejiang Pharmaceutical University, Ningbo, China.
Front Immunol. 2024 Jun 6;15:1378730. doi: 10.3389/fimmu.2024.1378730. eCollection 2024.
To explore the relationship between serum calcium levels and the prognosis of severe acute osteomyelitis, and to assess the effectiveness of calcium levels in prognostic evaluation.
Relevant patient records of individuals diagnosed with severe acute osteomyelitis were obtained for this retrospective study from the Medical Information Mart for Intensive Care (MIMIC-IV). The study aimed to assess the impact of different indicators on prognosis by utilizing COX regression analysis. To enhance prognostic prediction for critically ill patients, a nomogram was developed. The discriminatory capacity of the nomogram was evaluated using the Area Under the Curve (AUC) of the Receiver Operating Characteristic (ROC) curve, in addition to the calibration curve.
The study analyzed a total of 1,133 cases of severe acute osteomyelitis, divided into the survivor group (1,025 cases) and the non-survivor group (108 cases). Significant differences were observed between the two groups in terms of age, hypertension, sepsis, renal injury, and various laboratory indicators, including WBC, PLT, Ca2+, CRP, hemoglobin, albumin, and creatinine (P<0.05). However, no significant differences were found in race, gender, marital status, detection of wound microbiota, blood sugar, lactate, and ALP levels. A multivariate COX proportional hazards model was constructed using age, hypertension, sepsis, Ca2+, creatinine, albumin, and hemoglobin as variables. The results revealed that hypertension and sepsis had a significant impact on survival time (HR=0.514, 95% CI 0.339-0.779, P=0.002; HR=1.696, 95% CI 1.056-2.723, P=0.029). Age, hemoglobin, Ca2+, albumin, and creatinine also showed significant effects on survival time (P<0.05). However, no statistically significant impact on survival time was observed for the other variables (P>0.05). To predict the survival time, a nomogram was developed using the aforementioned indicators and achieved an AUC of 0.841. The accuracy of the nomogram was further confirmed by the ROC curve and calibration curve.
According to the findings, this study establishes that a reduction in serum calcium levels serves as a distinct and standalone predictor of mortality among individuals diagnosed with severe acute osteomyelitis during their stay in the Intensive Care Unit (ICU) within a span of two years.
探讨血清钙水平与严重急性骨髓炎预后的关系，并评估钙水平在预后评估中的有效性。
本回顾性研究从医疗信息监测与分析中心（MIMIC-IV）获得了确诊为严重急性骨髓炎患者的相关病历记录。研究旨在通过 COX 回归分析评估不同指标对预后的影响。为了提高危重病患者的预后预测能力，开发了一个列线图。使用接受者操作特征（ROC）曲线下面积（AUC）和校准曲线评估列线图的区分能力。
该研究共分析了 1133 例严重急性骨髓炎患者，分为幸存者组（1025 例）和非幸存者组（108 例）。两组在年龄、高血压、脓毒症、肾损伤和各种实验室指标（白细胞计数、血小板计数、Ca2+、C 反应蛋白、血红蛋白、白蛋白和肌酐）方面存在显著差异（P<0.05）。然而，在种族、性别、婚姻状况、伤口微生物检测、血糖、乳酸和碱性磷酸酶水平方面无显著差异。使用年龄、高血压、脓毒症、Ca2+、肌酐、白蛋白和血红蛋白作为变量构建多变量 COX 比例风险模型。结果表明，高血压和脓毒症对生存时间有显著影响（HR=0.514，95%CI 0.339-0.779，P=0.002；HR=1.696，95%CI 1.056-2.723，P=0.029）。年龄、血红蛋白、Ca2+、白蛋白和肌酐对生存时间也有显著影响（P<0.05）。然而，其他变量对生存时间无统计学意义（P>0.05）。为了预测生存时间，使用上述指标开发了一个列线图，其 AUC 为 0.841。ROC 曲线和校准曲线进一步证实了列线图的准确性。
根据研究结果，本研究确定血清钙水平降低是严重急性骨髓炎患者入住重症监护病房（ICU）两年内死亡的一个明显的独立预测因素。
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