重症急性胰腺炎合并腹内高压患者继发脓毒症的风险预测模型的建立与评价OA

Objective To conduct an analysis of risk factors associated with secondary sepsis in patients diagnosed with severe acute pancreatitis(SAP)accompanied by intra-abdominal hypertension(IAH),and to construct and validate a prediction model.Methods A retrospective analysis was conducted on clinical data of patients with SAP complicated by IAH admitted to the Intensive Care Unit of our hospital from January 2017 to April 2023.Univariate analysis was used to compare differences in clinical data between sepsis group and non-sepsis group.Variables with statistical significance in the univariate analysis(P＜0.05)were included in the Logistic regression analysis to select independent influencing factors,and a risk prediction model was established based on the regression coefficients of each independent influencing factor.The area under the ROC curve(AUC)and the Hos-mer-Lemeshow(H-L)test were used to evaluate the model and to compare the AUC of the prediction model with that of the A-PACHE Ⅱ scoring system and the SOFA scoring system.Internal validation was performed by using Bootstrap re-sampling of 1000 times.Results Total 232 patients were included,among whom 106(45.7％)developed sepsis.Univariate analysis revealed sta-tistically significant differences in age,heart rate,oxygen saturation,intra-abdominal pressure,pH value,PaCO2,hemoglobin,hema-tocrit,APTT,blood creatinine,and whether mechanical ventilation was maintained within 4 hours of admission to the ICU(P＜0.05).Results of the Logistic regression analysis indicated that age,heart rate,PaCO2,APTT,intra-abdominal pressure,and blood creatinine were independent influencing factors for the development of sepsis in patients with severe acute pancreatitis(SAP)com-plicated by intra-abdominal hypertension(IAH).The risk prediction model based on the regression coefficients of independent in-fluencing factors demonstrated better prediction efficiency.The area under the curve(AUC)of the model was 0.770(95％CI 0.710～0.831),with a sensitivity of 72.60％and a specificity of 70.00％.The x2 value of the model's Hosmer-Lemeshow test was 8.1,and P=0.424.The AUC predicted by the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)scoring system was 0.660(95％CI 0.590～0.730),with a sensitivity of 46.20％and a specificity of 77.00％.The AUC predicted by the sequential organ failure assessment(SOFA)scoring system was 0.692(95％CI 0.623～0.761),with a sensitivity of 54.70％and a specificity of 79.40％.The difference in predictive efficacy between the risk prediction model and the APACHE Ⅱ scoring system as well as the SOFA scoring system was statistically significant(P＜0.05).The AUC of 1000-times bootstrap resampling for internal validation was 0.770(95％CI 0.709～0.829),and the calibration curve was generally consistent with the actual curve,with a C-index of 0.770.Conclusion The risk prediction model for secondary sepsis in patients with SAP complicated by IAH established in this study has good predictive performance and can be used by clinical staff to identify high-risk individuals for sepsis early and take preventive and therapeutic measures to improve the prognosis of patients with SAP complicated by IAH.