Construction and validation of a predictive model for septic shock based on propensity score matching
- VernacularTitle: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
- Author:
Yang FANG
1
;
Ying LI
;
Zhihong CHEN
;
Shengnan ZHENG
;
Jian GONG
;
Qihua WU
;
Xiaoyu YANG
;
Xiuping WEN
;
Donghong LIN
Author Information
- Keywords: sepsis; septic shock; C-reactive protein; procalcitonin; interleukin-6; serum amyloid A
- From: Journal of Clinical Medicine in Practice 2024;28(21):53-59
- CountryChina
- Language:Chinese
- 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.
