PDF(Pubmed)
Abstract：
BACKGROUND: Studies on prognostic factors for older patients with intra-abdominal sepsis are scarce, and the association between skeletal muscle mass and prognosis among such patients remains unclear.
OBJECTIVE: To develop a nomogram to predict in-hospital mortality among older patients with intra-abdominal sepsis.
METHODS: Older patients with intra-abdominal sepsis were prospectively recruited. Their demographics, clinical features, laboratory results, abdominal computed tomography-derived muscle mass, and in-hospital mortality were recorded. The predictors of mortality were selected via least absolute shrinkage and selection operator and multivariable logistic regression analyses, and a nomogram was developed. The nomogram was assessed and compared with Sequential Organ Failure Assessment score, Acute Physiology and Chronic Health Evaluation II score, and Simplified Acute Physiology Score II.
RESULTS: In total, 464 patients were included, of whom 104 (22.4%) died. Six independent risk factors (skeletal muscle index, cognitive impairment, frailty, heart rate, red blood cell distribution width, and blood urea nitrogen) were incorporated into the nomogram. The Hosmer-Lemeshow goodness-of-fit test and calibration plot revealed a good consistency between the predicted and observed probabilities. The area under the receiver operating characteristic curve was 0.875 (95% confidence interval = 0.838-0.912), which was significantly higher than those of commonly used scoring systems. The decision curve analysis indicated the nomogram had good predictive performance.
CONCLUSIONS: Our nomogram, which is predictive of in-hospital mortality among older patients with intra-abdominal sepsis, incorporates muscle mass, a factor that warrants consideration by clinicians. The model has a high prognostic ability and might be applied in clinical practice after external validation.
OBJECTIVE: To develop a nomogram to predict in-hospital mortality among older patients with intra-abdominal sepsis.
METHODS: Older patients with intra-abdominal sepsis were prospectively recruited. Their demographics, clinical features, laboratory results, abdominal computed tomography-derived muscle mass, and in-hospital mortality were recorded. The predictors of mortality were selected via least absolute shrinkage and selection operator and multivariable logistic regression analyses, and a nomogram was developed. The nomogram was assessed and compared with Sequential Organ Failure Assessment score, Acute Physiology and Chronic Health Evaluation II score, and Simplified Acute Physiology Score II.
RESULTS: In total, 464 patients were included, of whom 104 (22.4%) died. Six independent risk factors (skeletal muscle index, cognitive impairment, frailty, heart rate, red blood cell distribution width, and blood urea nitrogen) were incorporated into the nomogram. The Hosmer-Lemeshow goodness-of-fit test and calibration plot revealed a good consistency between the predicted and observed probabilities. The area under the receiver operating characteristic curve was 0.875 (95% confidence interval = 0.838-0.912), which was significantly higher than those of commonly used scoring systems. The decision curve analysis indicated the nomogram had good predictive performance.
CONCLUSIONS: Our nomogram, which is predictive of in-hospital mortality among older patients with intra-abdominal sepsis, incorporates muscle mass, a factor that warrants consideration by clinicians. The model has a high prognostic ability and might be applied in clinical practice after external validation.
摘要：
背景：关于老年腹内脓毒症患者预后因素的研究很少，这些患者的骨骼肌质量与预后之间的关系尚不清楚。
目的：建立一个列线图来预测老年腹内脓毒症患者的院内死亡率。
方法：前瞻性招募老年腹内脓毒症患者。他们的人口统计，临床特征,实验室结果,腹部计算机断层扫描衍生的肌肉质量，并记录住院死亡率.通过最小绝对收缩率和选择算子和多变量逻辑回归分析选择死亡率的预测因子，并绘制了列线图。评估列线图，并与序贯器官衰竭评估评分进行比较，急性生理学和慢性健康评估II评分，和简化急性生理学评分II。
结果：总计，包括464例患者，其中104人（22.4%）死亡。六个独立的危险因素（骨骼肌指数，认知障碍，脆弱,心率,红细胞分布宽度,和血尿素氮）被纳入列线图。Hosmer-Lemeshow拟合优度测试和校准图显示了预测和观察到的概率之间的良好一致性。受试者工作特征曲线下面积为0.875(95%置信区间=0.838-0.912),明显高于常用的评分系统。决策曲线分析表明，列线图具有良好的预测性能。
结论：我们的列线图，这可以预测老年腹内脓毒症患者的院内死亡率，结合肌肉质量，一个值得临床医生考虑的因素。该模型具有较高的预测能力，经外部验证后可用于临床实践。
目的：建立一个列线图来预测老年腹内脓毒症患者的院内死亡率。
方法：前瞻性招募老年腹内脓毒症患者。他们的人口统计，临床特征,实验室结果,腹部计算机断层扫描衍生的肌肉质量，并记录住院死亡率.通过最小绝对收缩率和选择算子和多变量逻辑回归分析选择死亡率的预测因子，并绘制了列线图。评估列线图，并与序贯器官衰竭评估评分进行比较，急性生理学和慢性健康评估II评分，和简化急性生理学评分II。
结果：总计，包括464例患者，其中104人（22.4%）死亡。六个独立的危险因素（骨骼肌指数，认知障碍，脆弱,心率,红细胞分布宽度,和血尿素氮）被纳入列线图。Hosmer-Lemeshow拟合优度测试和校准图显示了预测和观察到的概率之间的良好一致性。受试者工作特征曲线下面积为0.875(95%置信区间=0.838-0.912),明显高于常用的评分系统。决策曲线分析表明，列线图具有良好的预测性能。
结论：我们的列线图，这可以预测老年腹内脓毒症患者的院内死亡率，结合肌肉质量，一个值得临床医生考虑的因素。该模型具有较高的预测能力，经外部验证后可用于临床实践。
