Qin Hongmei, Liu Ke, Fu Yaoqing, Wu Xin
Department of Critical Care Medicine, The First People's Hospital of Yulin, Yulin, Guangxi, China.
Medicine (Baltimore). 2025 Jun 27;104(26):e42950. doi: 10.1097/MD.0000000000042950.
Sepsis, a life-threatening systemic inflammatory response syndrome triggered by infection, is associated with high morbidity and substantial short-term mortality. This study aimed to develop and validate a nomogram for predicting 28-day mortality risk in sepsis patients admitted to the intensive care unit (ICU). The study included 338 sepsis patients who met the inclusion criteria. Of these, 229 patients from the ICU with sepsis from January 2018 to December 2021 were assigned to the training set, and 109 ICU sepsis patients from January 2022 to December 2023 made up the validation set. Following a 28-day ICU stay, the training set was categorized into survivors (169 patients) and non-survivors (60 patients) based on their outcomes. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for mortality in sepsis patients. A nomogram was then constructed using these risk factors to estimate the 28-day mortality risk for ICU patients diagnosed with sepsis. The nomogram's predictive accuracy was assessed using the area under the curve from the receiver operating characteristic curve, along with calibration and decision curve analysis. Logistic regression analysis indicated that sequential organ failure assessment (OR = 1.368, 95% CI = 1.175-1.773), disseminated intravascular coagulation (OR = 1.225, 95% CI = 1.195-1.924), white blood cell (OR = 1.181, 95% CI = 1.012-1.378), and interleukin-6 (OR = 1.063, 95% CI = 0.920-1.208) are independent factors influencing mortality in ICU patients with sepsis within a 28-day period. The receiver operating characteristic curve analysis revealed area under the curves of 0.913 (95% CI = 0.863-0.963) for the training set and 0.799 (95% CI = 0.669-0.929) for the validation set. Additionally, the calibration curves for both datasets closely correspond with the diagonal line, suggesting a strong fit. The decision curve analysis curve illustrates that the nomogram's training set along with the validation set offer an improved clinical net benefit. This research identified sequential organ failure assessment, disseminated intravascular coagulation, white blood cell, and interleukin-6 as independent factors affecting 28-day mortality in ICU sepsis patients and developed a predictive nomogram. This nomogram facilitates individualized prognostic assessment and offers a scientific basis for the widespread application of this risk-stratification tool in ICUs.
脓毒症是一种由感染引发的危及生命的全身炎症反应综合征，具有高发病率和较高的短期死亡率。本研究旨在开发并验证一种用于预测入住重症监护病房（ICU）的脓毒症患者28天死亡风险的列线图。该研究纳入了338例符合纳入标准的脓毒症患者。其中，2018年1月至2021年12月来自ICU的229例脓毒症患者被分配到训练集，2022年1月至2023年12月的109例ICU脓毒症患者组成验证集。在ICU住院28天后，根据训练集患者的结局将其分为幸存者（169例）和非幸存者（60例）。进行单因素和多因素逻辑回归分析以确定脓毒症患者死亡的独立危险因素。然后使用这些危险因素构建列线图，以估计诊断为脓毒症的ICU患者的28天死亡风险。使用受试者工作特征曲线下面积、校准和决策曲线分析评估列线图的预测准确性。逻辑回归分析表明，序贯器官衰竭评估（OR = 1.368，95%CI = 1.175 - 1.773）、弥散性血管内凝血（OR = 1.225，95%CI = 1.195 - 1.924）、白细胞（OR = 1.181，95%CI = 1.012 - 1.378）和白细胞介素-6（OR = 1.06⒊95%CI = 0.920 - 1.208）是影响ICU脓毒症患者28天内死亡的独立因素。受试者工作特征曲线分析显示，训练集曲线下面积为0.913（95%CI = 0.863 - 0.963），验证集为0.799（95%CI = 0.669 - 0.929）。此外，两个数据集的校准曲线与对角线密切对应，表明拟合良好。决策曲线分析曲线表明，列线图的训练集和验证集提供了更好的临床净效益。本研究确定序贯器官衰竭评估、弥散性血管内凝血、白细胞和白细胞介素-6为影响ICU脓毒症患者28天死亡的独立因素，并开发了一种预测列线图。该列线图有助于进行个体化预后评估，并为这种风险分层工具在ICU中的广泛应用提供了科学依据。
