基于新型复合指标构建脓毒症患者预后列线图模型

Construction of a prognostic nomogram model for sepsis patients based on novel composite indicators

摘要

目的：基于中性粒细胞与血小板比值（NPR）、中性粒细胞与单核细胞比值（NMR）、乳酸与血细胞比容比值（LHR），构建并验证脓毒症患者预后的列线图预测模型，以期为临床预后评估提供可视化工具。方法：采用回顾性队列研究设计，选取2021年2月至2025年2月泸州市中医医院收治的228例脓毒症患者作为研究对象，收集一般资料、实验室指标、疾病严重度评分以及治疗信息等。根据住院结局将患者分为死亡组（96例）和存活组（132例）。采用多因素Logistic回归分析筛选28天全因死亡的危险因素，并基于回归结果构建列线图预测模型。通过Bootstrap法进行内部验证，采用受试者工作特征曲线（ROC）、校准曲线及决策曲线分析（DCA）评估模型的区分度、校准能力和临床实用性。结果：死亡组NPR、NMR与LHR均高于存活组（P<0.05）。多因素Logistic回归分析结果显示，NPR升高、NMR升高、LHR升高、APACHE Ⅱ评分升高及SOFA评分升高均为脓毒症患者28天全因死亡的独立危险因素（P<0.05）。基于回归结果构建列线图预测模型，经验证该模型具有较好的拟合优度（Hosmer⁃Lemeshow检验χ²=5.032,P>0.05）、校准度（平均绝对误差=0.005，C⁃index=0.992）和区分度（AUC=0.992，95%CI：0.986~0.999），并具备较高的临床实用性。结论：脓毒症患者NPR、NMR与LHR升高与28天全因死亡风险增加密切相关，基于NPR、NMR与LHR构建的列线图预测模型能有效预测脓毒症患者的28天全因死亡风险。

Abstract

Objective: To develop and validate a nomogram prediction model for the prognosis of sepsis patients based on the neutrophil⁃to⁃platelet ratio (NPR), neutrophil⁃to⁃monocyte ratio (NMR), and lactate⁃to⁃hematocrit ratio (LHR), in order to provide a visual tool for prognostic assessment. Methods: A retrospective cohort study was conducted involving 228 sepsis patients admitted to Luzhou Traditional Chinese Medicine Hospital between February 2021 and February 2025. General information, laboratory indicators, disease severity scores, and treatment details were collected. Patients were divided into a death group (96 cases) and a survival group (132 cases) based on the outcomes of 28⁃day mortality. Multivariate logistic regression analysis was used to identify factors influencing 28⁃day mortality. A nomogram prediction model was constructed based on the regression results and internally validated using the Bootstrap method. The model's discriminative ability, calibration, and clinical applicability were evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results: The death group had significantly higher NPR, NMR, and LHR levels as compared with the survival group (P<0.05). Multivariate logistic regression analysis showed that increased NPR, NMR, LHR, APACHE Ⅱ score, and SOFA score were risk factors for 28⁃day mortality in sepsis patients (P<0.05). The nomogram prediction model constructed based on these factors demonstrated good goodness⁃of⁃fit (Hosmer⁃Lemeshow test:χ²=5.032, P>0.05), calibration (mean absolute error=0.005, C⁃index=0.992), discriminative ability (area under the curve (AUC)=0.992 (95%CI: 0.986⁃0.999)), and clinical utility. Conclusion: Elevated NPR, NMR, and LHR are associated with an increased risk of 28⁃day mortality in sepsis patients. The nomogram prediction model based on NPR, NMR, and LHR can effectively predict the risk of 28⁃day mortality in these patients.

关键词

脓毒症 / 预后 / 列线图 / 中性粒细胞/血小板比值 / 中性粒细胞/单核细胞比值 / 乳酸/血细胞比容比值

Key words

Sepsis / Prognosis / Nomogram / Neutrophil⁃to⁃Platelet Ratio / Neutrophil⁃to⁃Monocyte Ratio / Lactate⁃to⁃Hematocrit Ratio

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