Analysis Of Risk Factors And Establishment Of Predictive Model Of Sepsis Post-multiple Trauma

Objective:The population baseline information and clinical data of patients with multiple injuries were collected by electronic medical record system to explore the related risk factors of sepsis in patients with multiple injuries and the value of albumin（Alb）combined with neutrophil to lymphocyte ratio（NLR）in predicting the occurrence of sepsis in patients with multiple injuries.Based on the selected risk factors of sepsis in patients with multiple injuries,a prediction model of sepsis was established in order to provide a simple and effective early warning method for sepsis.Methods:The clinical data of 427 patients with multiple injuries treated in the Department of Emergency surgery of a provincial third-class hospital from January 2015 to December 2020 were retrospectively analyzed.They were divided into two groups:sepsis group（n=285）and non-sepsis group（n=142）according to the complication of sepsis.The differences of age,sex,body mass index（BMI）,smoking history,past health status,admission time,vital signs within 24 hours after admission,injury,related critical score and related laboratory physiological and biochemical indexes were compared between the two groups.The independent risk factors of sepsis in patients with multiple injuries were screened by univariate and multivariate Logistic regression analysis,and a predictive model was established according to the results of the analysis and verified by Kappa test.The predictive value of the predictive model for sepsis in patients with multiple injuries was evaluated by drawing the working characteristic curve of the subjects（ROC）.Results:Through the comparison of the data of the two groups,it was found that within 24hours of admission,shock,central venous catheterization,blood transfusion,mechanical ventilation ratio,body temperature,heart rate,systolic blood pressure,mechanical ventilation time,ISS score,NISS score,APACHE-Ⅱscore,SOFA score,WBC,NEUT,neutrophil to lymphocyte ratio（NLR）,APTT,PT,INR,PCT,CRP,UREA,Scr,K⁺,Na⁺,Pa O₂,RBC,PLT,HCT,LYMPH,TT,Alb,there were significant differences in blood PH value and other indexes.The results of further univariate and multivariate Logistic analysis showed that Mechanical ventilation（OR=3.174,95%CI:1.164～15.901,P=0.002）,ISS score（OR=1.672,95%CI:1.159～1.943,P=0.014）,APACHE-Ⅱ（OR=1.384,95%CI:1.046～1.738,P=0.031）,SOFA（OR=1.285,95%CI:1.085～3.241,P=0.027）,Alb（OR=0.613,95%CI:0.547～0.829,P<0.001）,NLR（OR=1.339,95%CI:1.019～2.454,P=0.036）,APTT（OR=4.993,95%CI:2.683～9.744,P<0.001）.The ROC curve showed that the sensitivity,specificity,AUC,95%CI and Jordan index of Alb combined with NLR in predicting sepsis in patients with multiple injuries were 93.56%,87.29%,0.966,0.947～0.973 and 0.809 respectively,which were significantly higher than those predicted alone（P<0.05）.The independent risk factors screened by multivariate analysis were selected as the independent variables of the prediction model of sepsis,and the prediction model of sepsis in patients with multiple injuries was established.The consistency test of the regression model showed that the Kappa value of ROC curve analysis showed that the area under the ROC curve of sepsis early warning model for predicting sepsis in patients with multiple injuries was 0.975.It was significantly higher than ISS（AUC=0.831）,APACHE-Ⅱ（AUC=0.783）,SOFA（AUC=0.898）,Alb（AUC=0.781）,NLR（AUC=0.816）and APTT（AUC=0.916）.When the best cut-off value in the sepsis prediction model was 0.638,the sensitivity was 94.82%and the specificity was 87.76%.Conclusion:Mechanical ventilation,ISS score,APACHE-Ⅱ,SOFA,Alb,NLR and APTT are independent risk factors for sepsis in patients with multiple injuries.The prediction model established by regression analysis has strong consistency,and compared with the traditional single biomarker to predict the occurrence of sepsis,the joint prediction model has better predictive value.Clinically,it is necessary to closely monitor the laboratory physiological and biochemical indexes of patients with multiple injuries 24hours after injury,and early intervention of abnormal indexes is expected to reduce the incidence of sepsis in patients with multiple injuries.