Clinical value of a predictive model based on acute skin failure in determining the 28-day prognosis of patients with sepsis
10.3760/cma.j.cn211501-20230627-01544
- VernacularTitle:急性皮肤衰竭联合预测模型对脓毒症患者28天生存预后的判断价值
- Author:
Jia CHEN
1
;
Jing WANG
;
Xiufang QIN
Author Information
1. 上海中医药大学附属曙光医院急诊科，上海 201203
- Keywords:
Sepsis;
Nomograph;
Survival prognosis;
Acute skin failure;
Prediction model
- From:
Chinese Journal of Practical Nursing
2023;39(32):2507-2514
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To construct a predictive model based on acute skin failure, and to evaluate its predictive value on the 28-day prognosis of patients with sepsis, to provide a basis for medical staff to develop effective intervention measures.Methods:A prospective survey method was adopted, 231 patients with sepsis hospitalized in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from May 2020 to April 2023 were enrolled as the research subjects, of which 162 patients from May 2020 to March 2022 were allocated into the test group for construct a prediction model, and 69 patients from April 2022 to April 2023 in the validation group for external validation. Univariate and multivariate Logistic regression were implemented to analyze the risk factors of 28-day mortality in sepsis patients, construction of a joint prediction model based on acute skin failure, and drawing of a column chart to verify its accuracy.Results:The 53 of 162 cases in the test group died, with mortality rate of 32.7%. The 19 of 69 cases in the validation group died, with mortality rate of 27.5%, there was no statistically significant difference in mortality rates between the two groups ( χ2 = 0.61, P = 0.437). The results of multivariate analysis in the test group showed that APACHE II score ( OR = 0.674, 95% CI 0.509-0.631), Sequential Organ Failure Assessment ( OR = 0.391, 95% CI 0.242-0.631), lactate ( OR = 2.291, 95% CI 1.306-4.019), skin mottling score ( OR = 2.950, 95% CI 1.586-5.488), skin wet cold ( OR = 3.678, 95% CI 0.910-1.865), capillary filling time>2 s ( OR = 6.070, 95% CI 0.774-1.579), decreased fingertip transcutaneous oxygen saturation ( OR = 2.046, 95% CI 1.312-2.076), and weakened skin sensation ( OR = 3.354, 95% CI 0.796-1.124) were independent risk factors that affecting the 28-day mortality of patients with sepsis. The verification results of combined predictive model for acute skin failure showed that the C-index of test group and validation group were 0.834 and 0.811 respectively; the areas under ROC curve were 0.834 and 0.807, respectively. Conclusions:Acute skin failure-based nomogram model can predict the 28-day mortality of patients with sepsis, and help medical staff to implement personalized intervention measures.
