炎症-免疫-代谢三维轨迹预测脓毒症幸存患者1年生活质量:一项单中心纵向队列分析OA
Inflammation-immunity-metabolism three-dimensional trajectories for predicting 1-year quality of life in sepsis survivors:A single-center longitudinal cohort analysis
目的 利用群组多轨迹模型(GBMTM)识别脓毒症幸存患者炎症-免疫-代谢三维轨迹,探讨不同轨迹表型与幸存患者出院后1年生活质量的关联.方法 回顾性选取2018年1月至2023年1月温州医科大学附属第一医院收治的脓毒症幸存患者412例.收集患者入院后5 d内4个时间点的C反应蛋白(炎症)、淋巴细胞绝对值(免疫)和白蛋白(代谢)纵向数据.采用欧洲五维五水平健康量表评估患者出院后1年的生活质量;采用GBMTM识别炎症-免疫-代谢三维轨迹,并利用多因素Logistic回归分析不同轨迹亚组与出院后1年生活质量下降的关系.结果 识别出3种不同的炎症-免疫-代谢轨迹亚型,Class 1(低炎-低免疫-代谢稳定型)、Class 2(持续高炎-免疫抑制-代谢不良型)、Class 3(炎症消退-免疫保留-代谢改善型).Class 2出院后1年生活质量下降发生率[50.56%(180/356)],高于Class 3、Class 1[分别为31.82%(7/22)、26.47%(9/34);χ2值为0.009,P<0.05].多因素Logistic回归分析显示,在校正混杂因素后,以Class 1为参照,Class 2轨迹是出院后1年生活质量下降的独立危险因素(OR=3.192,95%CI:1.394～7.902,P=0.009).模型受试者操作特征曲线下面积为0.758,校准曲线和决策曲线分析均显示模型具有良好的预测价值和临床实用价值.结论 本研究通过GBMTM识别出脓毒症幸存患者3种炎症-免疫-代谢三维轨迹.Class 2轨迹与脓毒症幸存患者出院后1年生活质量下降独立相关.
Objective To identify three-dimensional inflammation-immunity-metabolism trajectories in sepsis survivors using group-based multi-trajectory modeling(GBMTM)and to explore the association between different trajectory phenotypes and quality of life one year after hospital discharge.Methods A total of 412 sepsis survivors admitted to the First Affiliated Hospital of Wenzhou Medical University from January 2018 to January 2023 were retrospectively enrolled.Longitudinal data on C-reactive protein(inflammation),absolute lymphocyte count(immunity),and albumin(metabolism)were collected at four time points within 5 days after admission.Quality of life one year after discharge was assessed using the EuroQol Five-Dimensional Five-Level Health Scale(EQ-5D-5L).GBMTM was applied to identify inflammation-immunity-metabolism trajectories.Multivariate logistic regression analysis was performed to explore the association between different trajectory subgroups and the decreased quality of life at one year after discharge.Results Three distinct inflammation-immunity-metabolism trajectory subtypes were identified:Class 1(low inflammation-low immunity-stable metabolism type),Class 2(persistent high inflammation-immunosuppression-poor metabolism type),and Class 3(resolving inflammation-preserved immunity-improved metabolism type).The incidence of decreased quality of life one year after discharge in Class 2[50.56%(180/356)]was significantly higher than that in Class 3[31.82%(7/22)]and Class 1[26.47%(9/34)](χ2=0.009,P<0.05).Multivariate logistic regression analysis revealed that,after adjusting for confounding factors,using Class 1 as the reference,the Class 2 trajectory served as an independent risk factor for decreased quality of life at one year after discharge(OR=3.192,95%CI:1.394-7.902,P=0.009).The area under the receiver operating characteristic curve of the model was 0.758,and both calibration curve and decision curve analysis demonstrated favorable predictive value and clinical utility of the model.Conclusions This study identified three inflammation-immunity-metabolism three dimensional trajectories in sepsis survivors using GBMTM.The Class 2 trajectory was independently associated with decreased quality of life at one year discharge in sepsis survivors.
骆琳玓;吴倩雯;赵光举;姚奕
温州医科大学附属第一医院急诊医学科,浙江 温州 325000温州医科大学附属第一医院急诊医学科,浙江 温州 325000温州医科大学附属第一医院急诊医学科,浙江 温州 325000温州医科大学附属第一医院急诊医学科,浙江 温州 325000
脓毒症脓毒症幸存患者生活质量EQ-5D-5L群组多轨迹模型
sepsissepsis survivorsquality of lifeEuroQol Five-Dimensional Five-Level Health Scalegroup-based multi-trajectory modeling
《感染、炎症、修复》 2026 (3)
249-255,7
国家自然科学基金(82272202)温州市高水平创新团队项目(2024R3002)
评论