| Objective:A retrospective study was conducted to analyze whether Charlson comorbidity index(CCI)with arterial lactate concentration was correlated with the short-term prognosis of sepsis patients,and a 28-day mortality risk prediction model was established to identify the severity of sepsis patients at an early stage and intervene as soon as possible,and reduce mortality.Methods:Based on Medical Information Mart for Intensive Care database(MIMIC IV),Structured Query Language(SQL)was used to extract sepsis patients who met the Sepsis3.0 diagnostic criteria,and then according to the inclusion and exclusion criteria,the general information,basic vital signs,results of laboratory tests,treatment and other data of 10721 patients within 24 hours of admission to Intensive Care Unit(ICU)were collected.The 28-day mortality was used as the outcome indicator.All patients were divided into two groups: Death Group(2130cases)and Survival Group(8591 cases).Comparison of two groups of baseline,CCI scores,arterial lactate concentration difference.Logistic regression was used to analyze the severity of the disease and its influencing factors.ROC curve was used to evaluate the prognostic value of CCI score and arterial lactate concentration alone and in combination.Results:1.There were no significant differences in gender,body temperature(T),body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),platelet minimum(PLT min)and hematocrit minimum(HCT min)between the death group and the survival group(P> 0.05).2.Compared with the survival group,the death group was slightly older,the heart rate(HR)and respiratory rate(RR)were faster,and the CCI score,arterial lactate concentration,SOFA score,APACHEII score,WBC,AST,ALT,TBil,blood sodium concentration,ICU length of stay,mechanical ventilation time,and vasoactive drug use time were higher.However,the mean arterial pressure,initial blood oxygen saturation,total length of hospital stay,potassiumion,chloride ion concentration,hemoglobin and hematocrit were all lower(P<0.05).3.Multivariate Logistic regression analysis showed that arterial lactate concentration,CCI score,SOFA score,APACHE II score,HCT max,RR,WBC min,and maximum serum sodium concentration were independent risk factors for sepsis(P<0.05).ROC curve was used to establish a prediction model for the above indicators.The AUC were as follows: CCI score 0.713(95%CI: 0.602-0.629),arterial lactate concentration 0.610(95%CI: 0.595-0.625);Lac+CCI score 0.766(95%CI: 0.753-0.778),APACHE II score 0.788(95%CI: 0.777-0.798),SOFA score0.615(95%CI: 0.602-0.629),RR 0.658(95%CI: 0.753-0.778)0.645-0.671),WBC min 0.532(95%CI: 0.517-0.547),HCT max 0.480(95%CI: 0.458-0.487),and maximum serum sodium concentration 0.521(95%CI: 0.505-0.536).The sensitivity and specificity of SOFA score,APACHE II score,lactate concentration,CCI score,Lac+CCI score and respiratory rate were(54.8,63.8),(74.7,67.6),(34.7,86.1),(55.9,75.3),(62.9,77.3),(63.3,62.8),respectively.Conclusions:High CCI score,arterial lactate concentrations are short-term impact sepsis patients independent risk factor for poor prognosis.The combination of CCI score and arterial lactate concentration in predicting the 28-day mortality of patients with sepsis has certain advantages over single index,but compared with APACHE II score,the predictive value is slightly worse. |
