脓毒症早期中医证候动态演变与28 d死亡风险预测模型研究OA

Objective:To explore the dynamic evolution trajectory of traditional Chinese medicine(TCM)syn-dromes in patients with early sepsis,construct a 28-day mortality risk prediction model for sepsis patients based on the dynamic evolution of TCM syndromes,and analyze its predictive value.Methods:A total of 131 patients with sepsis admitted to Cangzhou Hospital of Integrated Traditional Chinese and western Medicine in Hebei Prov-ince from February 2022 to January 2024 were included.TCM syndrome assessments were performed at 0 h,24 h,and 48 h.The group-based trajectory model(GBTM)was used to analyze the dynamic evolution trajectory of TCM syndromes in sepsis patients.Multivariate Cox regression analysis was used to analyze the relationship between the TCM syndrome evolution trajectory and 28-day mortality risk,construct a prediction model for mortality risk in sepsis patients,and evaluate its predictive efficacy.Results:The optimal model fitted by GBTM divided the TCM syndrome evolution trajectories of sepsis patients into 3 subgroups:the persistent heat-toxin and blood stasis syn-drome group,the heat-toxin transforming to deficiency syndrome group,and the whole-course deficiency syndrome group.Multivariate Cox regression analysis showed that platelet(PLT)(HR=0.992),white blood cell count(HR=1.104),Sequential Organ Failure Assessment(SOFA)score(HR=1.252),Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score(HR=1.148),and heat-toxin transforming to deficiency syndrome(HR=2.667)were risk factors for 28-day mortality in sepsis patients(P＜0.05).The receiver operating characteristic(ROC)curve showed that the prediction model combining PLT,white blood cell count,SOFA score,APACHE Ⅱ score,and TCM syndrome evolution trajectory had a higher area under the curve(AUC)of 0.938 for predicting 28-day mortality risk in sepsis patients than individual indicators.Conclusion:The evolution trajectories of TCM syn-dromes in sepsis patients are heterogeneous with different evolution trends.The heat-toxin transforming to deficien-cy syndrome is a risk factor for 28-day mortality in sepsis patients,and the combined prediction model can assist in clinically identifying high-risk groups for 28-day mortality in sepsis patients.