多种指数对脓毒性休克患者28 d预后的预测价值

Predictive value of multiple indices for 28-day prognosis in patients with septic shock

摘要

目的 评估简化免疫失调指数、全身免疫炎症指数（SII）、预后营养指数（PNI），及毛细血管渗漏指数（CLI）对成人脓毒性休克患者的短期预后的预测价值。 方法 选取兰州大学第一医院重症医学科2021年3月—2024年3月收治的262例成人脓毒性休克患者，依据患者进入重症监护病房后28 d的临床结局分为存活组（n=113）和死亡组（n=149），比较2组患者临床数据，使用随机森林和LASSO的Logistic回归筛选出影响脓毒性休克患者28 d死亡的独立危险因素作为自变量，进行多因素Logistic回归分析。利用受试者操作特征曲线评估简化免疫失调指数、SII、PNI、CLI等指标在预测脓毒性休克患者28 d短期结局的价值，并最终构建列线图模型。 结果 死亡组简化免疫失调指数、SII、CLI、脓毒症相关性器官功能衰竭评价评分均高于存活组（P<0.05），淋巴细胞计数、PNI小于存活组患者（P<0.05）。联合预测的受试者操作特征曲线下面积为0.96，95% CI：[0.94，0.98]， P<0.05。 结论 淋巴细胞计数、简化免疫失调指数、SII、PNI、CLI、脓毒症相关性器官功能衰竭评价评分是预测脓毒性休克患者短期预后的独立危险因素，其列线图模型可有效预测脓毒性休克28 d死亡风险，临床实用性强。

Abstract

Objective To evaluate the predictive value of the simplified immune dysregulation index, systemic immune-inflammation index (SII), prognostic nutritional index (PNI), and capillary leakage index (CLI) for short-term prognosis in adult patients with septic shock. Methods A total of 262 adult septic shock patients admitted to the intensive care unit of The First Hospital of Lanzhou University from March 2021 to March 2024 were retrospectively analyzed. Patients were categorized into survival (n=113) and death (n=149) groups based on 28 day outcomes, and clinical data were compared between the groups. Independent risk factors for 28 day mortality were identified using random forest and LASSO Logistic regression, followed by a multivariate Logistic regression analysis. Receiver operating characteristic curves were used to evaluate the predictive performance of the simplified immune dysregulation index, SII, PNI, and CLI. A nomogram model was subsequently constructed. Results The death group exhibited significantly higher simplified immune dysregulation index, SII, CLI, and sepsis-related organ failure assessment score compared with the survival group (P<0.05), while lymphocyte count and PNI were lower (P<0.05). The combined predictive model demonstrated an area under the receiver operating characteristic curve of 0.96, 95% CI: [0.94, 0.98], P<0.05. Conclusion Lymphocyte count, simplified immune dysregulation index, SII, PNI, CLI, and sepsis-related organ failure assessment score are independent risk factors for predicting short-term prognosis in septic shock patients, with the nomogram model incorporating these parameters demonstrating strong clinical applicability in predicting 28-day mortality risk of septic shock.

关键词

脓毒性休克 / 简化免疫失调指数 / 全身免疫炎症指数 / 预后营养指数 / 毛细血管渗漏指数 / 短期预后

Key words

septic shock / simplified immune dysfunction index / systemic immune-inflammation index / prognostic nutritional index / capillary leakage index / short-term prognosis

参考文献

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基金资助

国家自然科学基金地区科学基金资助项目(82160358)

甘肃省卫生健康行业科研资助项目(GSWSKY2022-31)