| 朱瑞,尹丹乔,王翠,等.基于血尿素氮构建列线图模型对老年脓毒症患者发生慢性危重症的预测价值[J].中国临床保健杂志,2025,28(1):125-130. |
| 基于血尿素氮构建列线图模型对老年脓毒症患者发生慢性危重症的预测价值 |
| Predictive value of a nomogram model constructed based on blood urea nitrogen combined with relevant indicators for the occurrence of chronic critical illness in elderly sepsis patients |
| 投稿时间：2024-09-02 |
| DOI：10.3969/J.issn.1672-6790.2025.01.024 |
| 中文关键词: 脓毒症 血尿素氮 疾病严重程度指数 老年人 |
| 英文关键词: Sepsis Blood urea nitrogen Severity of illness index Aged 〖FL |
| 基金项目:安徽省省级临床重点专科建设项目[2019(91号-1)]；安徽医科大学第一附属医院横向课题(hxkt-614) |
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| 中文摘要: |
| 目的 探讨血尿素氮(BUN)与老年脓毒症患者发生慢重症(CCI)之间的关系,评价基于血尿素氮联合相关指标构建的列线图模型对老年脓毒症患者发生CCI的预测价值。方法 采用回顾性队列研究收集重症医学监护信息数据库Ⅳ数据库中2008年至2019年的9 988例患者的病历资料,依据BUN水平将患者分为A组(BUN＜1.8 mg/L)、B组(1.8 mg/L≤BUN≤3.0 mg/L)和C组(BUN>3.0 mg/L)。研究纳入均为60岁以上的老年脓毒症患者,排除反复住入重症医学科、存活时间少于24 h、缺少24 h内序贯器官衰竭评估(SOFA)记录或BUN的患者。结局指标为患者发生CCI。采用单因素和多因素logistic回归分析指标对发生CCI的影响,结合预测因素建立列线图以预测老年脓毒症患者发生CCI的情况,并应用ROC曲线下面积(AUC)评估列线图辨别力。结果 与B、C组比较,A组患者的CCI发生率明显下降(A组:12.0%,B组:15.8%,C组:23.0%),且简化急性生理功能评分Ⅱ得分[A组:36(30,42)分,B组:38(32,45)分,C组:47(40,54)分]、Logistic器官功能障碍系统评分[A组:4(2,6)分,B组:4(3,7)分,C组:7(5,9)分]、牛津急性疾病严重程度评分[A组:32(27,38)分,B组:34(29,40)分,C组:36(30,43)分]均明显降低(P<0.05)。logistic回归分析发现,BUN增加是老年脓毒症患者发生CCI的独立预测因子。1.8 mg/L≤BUN≤3.0 mg/L的OR值为1.307,95%CI:1.117~1.529；BUN>3.0 mg/L的OR值为2.069,95%CI:1.170~2.437,P<0.001。以最终结果构建列线图,列线图的AUC为0.711。结论 BUN增加是影响老年脓毒症患者发生CCI的独立预测指标。BUN相关列线图有较好的区分度,能帮助临床医护人员评估老年脓毒症患者发生CCI的风险。 |
| 英文摘要: |
| Objective To explore the relationship between blood urea nitrogen (BUN) and the occurrence of chronic critical illness (CCI) in elderly sepsis patients,and to evaluate the predictive value of a nomogram model constructed based on BUN combined with relevant indicators for the occurrence of CCI in elderly sepsis patients.Methods A retrospective cohort study was conducted to collect medical records of 9 988 patients from the Intensive Care Medical Information Market Ⅳ database from 2008 to 2019.Patients were divided into Group A (BUN<1.8 mg/L),Group B (BUN:1.8-3.0 mg/L),and Group C (BUN>3.0 mg/L) based on their BUN levels.This study included elderly sepsis patients aged 60 and above,excluding those who were repeatedly admitted to the intensive care unit,had a survival time of less than 24 hours,and lacked records of sequential organ failure assessment (SOFA) or BUN within 24 hours.The outcome measure is the occurrence of CCI in patients.Single factor and multiple factor logistic regression analysis were used to investigate the impact of indicators on the occurrence of CCI.A column chart was established in combination with predictive factors to predict the occurrence of CCI in elderly sepsis patients,and the area under the ROC curve (AUC) was used to evaluate the discriminative power of the column chart.Results Compared with groups B and C,the incidence of CCI in group A patients was significantly reduced (group A:12.0%,group B:15.8%,group C:23.0%),and the simplified acute physiological function score II score [group A:36(30,42) points,group B:38(32,45) points,group C:47(40,54) points],logistic organ dysfunction system score [group A:4(2,6) points,group B:4(3,7) points,group C:7(5,9) points],Oxford acute disease severity score [group A:32(27,38) points,group B:34(29,40) points,group C:36(30,44) points].The scores were significantly reduced (P<0.05).Logistic regression analysis found that an increase in BUN is an independent predictor of CCI in elderly sepsis patients.The OR value for 1.8 mg/L ≤ BUN ≤ 3.0 mg/L is 1.307,95%CI:1.117-1.529;the OR value for BUN> 3.0 mg/L is 2.069,95%CI:1.170-2.437,P<0.001.Construct a column chart based on the final results,with an AUC of 0.711.Conclusions Increased BUN is an independent predictor of CCI occurrence in elderly sepsis patients.The BUN related column chart has good discrimination and can help clinical medical staff evaluate the risk of CCI in elderly patients with sepsis. |
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