海南医学院学报2023，Vol.29Issue(23)：1801-1808,8.DOI:10.13210/j.cnki.jhmu.20231031.001
控制营养状态评分对老年脓毒症进展为慢重症的预测价值
Predictive value of controlling nutritional status score for progression to chronic critical illness in elderly patients with sepsis
摘要
Abstract
Objective:To investigate the predictive value of controlling nutritional status(CONUT)score for progression to chronic critical illness sepsis in elderly patients,and to construct a predictive model based on CONUT score histogram.Meth-ods:Totally 739 elderly patients with sepsis admitted to the ICU of the Second Affiliated Hospital of Hainan Medical University from January 2020 to December 2022 were selected as the research subjects,and were divided into chronic critical illness group(n =188)and non-chronic critical illness group(n=551)according to whether chronic critical illness disease occurred.Clinical data of the patients were collected and compared.The predictive value of CONUT score,PNI and NLR in the progression of senile sepsis to chronic severe disease was compared,and the optimal threshold value was determined,which was used to convert the nu-merical variables into binary variables.Through univariate analysis and multivariate Logistic regression analysis,the risk factors af-fecting the progression of elderly sepsis patients to chronic critical illness disease were screened out,and the prediction model was built based on the nomogram.The efficacy and clinical utility of the prediction model were evaluated by the area under the ROC curve(AUC),calibration curve and decision curve analysis(DCA).Results:The best cut-off value for CONUT score in predict-ing elderly sepsis progressing to chronic critical illness was 4.The predictive performance of CONUT score(AUC=0.739)was better than that of PNI(AUC=0.609)and NLR(AUC=0.582)in elderly sepsis progressing to chronic critical illness(CONUT score vs.PNI:Z=5.960,P<0.001;CONUT score vs NLR:Z=6.119,P<0.001).Univariate analysis showed that age,CCI score,SOFA score,sepsis shock,serum Lac,CONUT score,mechanical ventilation(MV),and continuous renal replacement therapy(CRRT)treatment were related to elderly sepsis progressing to chronic critical illness(P<0.05).Multivariate logistic re-gression analysis showed that CONUT score≥4 points,age≥75 years,CCI score≥3,SOFA score>5,sepsis shock,and se-rum Lac≥4 mmol/L were independent risk factors for elderly sepsis progressing to chronic critical illness(P<0.05).The nomo-gram showed that CONUT score had the greatest contribution value in predicting elderly sepsis progressing to chronic critical ill-ness.Based on this,the nomogram prediction model had an AUC of 0.846[95%CI(0.812～0.879)],with a sensitivity of 75.5%and specificity of 81.3%,indicating good predictive performance.The calibration curve was close to the ideal curve,and the DCA threshold had clinical utility advantages when ranging from 0.1 to 0.9.Conclusion:The nomographic prediction model based on CONUT score can effectively predict the risk probability of senile sepsis progressing to chronic critical illness,and will be helpful for clinicians to identify the high risk group of chronic and severe senile sepsis,which is helpful for clinicians to identify high-risk populations of elderly sepsis with chronic critical illness.关键词
脓毒症/慢重症/CONUT评分/列线图/预测模型Key words
Sepsis/Chronic critical illness/The CONUT score/Nomograms/Prediction model分类
医药卫生引用本文复制引用
王晓苗,柴豆豆,邢柏..控制营养状态评分对老年脓毒症进展为慢重症的预测价值[J].海南医学院学报,2023,29(23):1801-1808,8.基金项目
This study was supported by Natural Science Foundation of Hainan Provincial(819MS128) 海南省自然科学基金项目(819MS128) （819MS128）
