实用临床医药杂志2024，Vol.28Issue(21)：53-59,7.DOI:10.7619/jcmp.20242165
基于倾向性评分匹配的脓毒性休克预测模型的构建与效能验证
Construction and validation of a predictive model for septic shock based on propensity score matching
摘要
Abstract
Objective To construct a predictive model for septic shock based on the propensity score matching(PSM)method and validate its effectiveness.Methods A total of 114 patients with sepsis were enrolled as study objects,and were divided into septic shock group(40 patients)and sep-sis group(74 patients)according to whether they developed septic shock.PSM was performed with a ratio of septic shock to sepsis of 1∶2,resulting in the inclusion of 30 patients in the septic shock group and 60 patients in the sepsis group after matching.The levels of C-reactive protein(CRP),procalcito-nin(PCT),interleukin-6(IL-6),serum amyloid A(SAA),soluble endothelial protein C receptor(sEPCR),endothelial cell-specific molecule 1(ESM-1),clusterin(CLU),and the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score and Sequential Organ Failure Assessment(SOFA)score at admission were compared between the two groups.Cox proportional hazards re-gression analysis was used to identify the factors influencing septic shock,and a predictive model for septic shock was constructed and internally validated using the receiver operating characteristic(ROC)curve.Kaplan-Meier survival curves were plotted to analyze the differences in survival prog-nosis among patients with different expression levels of the indicators.Results After matching,there were no statistically significant differences in general information between the two groups(P＞0.05).At admission,the septic shock group had higher levels of serum PCT,CRP,SAA,IL-6,sEPCR,ESM-1,and higher APACHE Ⅱ and SOFA scores,as well as a lower level of serum CLU compared with the sepsis group(P＜0.05).Cox regression analysis showed that PCT,CRP,SAA,IL-6,sEPCR,ESM-1,APACHE Ⅱ score,and SOFA score were independent risk factors for septic shock(P＜0.05),while CLU was an independent protective factor(P＜0.05).The predictive model for septic shock,constructed based on these factors,showed an internal validation accuracy of 94.44％,an area under the curve of 0.950,a sensitivity of 93.33％,and a specificity of 96.67％.Dead patients had higher levels of PCT,CRP,SAA,IL-6,sEPCR,ESM-1,and higher APACHE Ⅱ and SOFA scores,as well as a lower level of CLU at admission compared with survivors(P＜0.05).Compared with patients with low expression levels or low scores,patients with high ex-pression levels of PCT,CRP,SAA,IL-6,sEPCR,ESM-1,and high APACHE Ⅱ and SOFA scores had higher fatality rates,while patients with high CLU expression levels had a lower fatality rate(P＜0.05).Conclusion The serum biomarkers including PCT,CRP,SAA,IL-6,sEPCR,ESM-1,CLU,and the APACHE Ⅱ and SOFA scores in sepsis patients are closely related to the oc-currence of septic shock and survival prognosis.The predictive model constructed by combining these indicators can accurately predict the occurrence of septic shock.关键词
脓毒血症/脓毒性休克/C反应蛋白/降钙素原/白细胞介素-6/血清淀粉样蛋白AKey words
sepsis/septic shock/C-reactive protein/procalcitonin/interleukin-6/serum amyloid A分类
医药卫生引用本文复制引用
方杨,李莹,陈志洪,郑胜男,龚健,吴启华,杨晓宇,文秀平,林东鸿..基于倾向性评分匹配的脓毒性休克预测模型的构建与效能验证[J].实用临床医药杂志,2024,28(21):53-59,7.基金项目
湖南省自然科学基金青年基金项目(2020JJ5858) （2020JJ5858）
广东省深圳市龙岗区经济与科技发展专项资金项目(LGKCYLWS2020000492) （LGKCYLWS2020000492）
