基于血清炎性因子动态变化构建脓毒症患者28d生存预后预测模型OA

Objective To construct a 28-day survival prognosis prediction model for sepsis patients based on the dy-namic changes of serum inflammatory factors and to verify the predictive effectiveness of the model.Methods A retrospec-tive analysis was conducted on the medical records of 187 sepsis patients admitted to the general ward and Intensive Care Unit(ICU)of the Emergency Medicine Department at the Emergency Medicine Center of Nantong University Affiliated Hospital between November 2022 and November 2025.They were divided into a survival group and a mortality group based on their 28-day survival status.Serum procalcitonin(PCT)and high-sensitivity C-reactive protein(hs-CRP)levels were measured im-mediately upon admission(T0),48 hours after admission(T1),72 hours after admission(T2),and 7 days after admission(T3),and baseline data of the patients were collected.Independent risk factors for poor 28-day survival prognosis were identified through Cox regression analysis,and a nomogram prediction model was constructed based on these factors.The predictive ef-ficacy,calibration degree,and clinical practicability of the model were evaluated through receiver operating characteristic(ROC)curve analysis,calibration curve analysis,and decision curve analysis.Results Of the 187 patients,169 survived and 18 died,with a 28-day all-cause mortality rate of 9.63%.The proportion of patients aged≥60 years and the Sequential Organ Failure Assessment(SOFA)score were significantly higher in the mortality group than in the survival group(χ2/P=8.393/0.004,t/P=4.259/<0.001).Serum PCT and hs-CRP levels in the survival group showed a gradually decreasing trend at T1,T2,and T3 compared to T0(F/P=222.729/<0.001,287.902/<0.001).In the mortality group,serum PCT and hs-CRP levels showed a gradually increasing trend at T1 and T2 compared to T0,and decreased at T3(F/P=39.319/<0.001,56.831/<0.001).The levels of PCT and hs-CRP in the mortality group at T1-T3 were significantly higher than those in the survival group(t/P=19.908/＜0.001、65.848/＜0.001,60.545/＜0.001、79.925/＜0.001,29.775/＜0.001、332.407/＜0.001).Compared with the survival group,the mortality group showed significantly higher ΔPCT and Δhs-CRP(t/P=5.411/<0.001,7.529/<0.001).Age≥60 years,high SOFA score,and high levels of ΔPCT and Δhs-CRP were independent risk factors for poor 28-day survival prognosis in sepsis patients[HR(95%CI)=4.632(1.405-15.275),1.263(1.040-1.533),1.350(1.204-1.513),4.632(1.405-15.275)].Based on the independent risk factors mentioned above,a nomogram prediction model was constructed,with an area under the ROC curve(AUC)of 0.949,sensitivity of 0.793,specificity of 0.944,and Youden index of 0.737,indicating good predictive performance.The calibration curve showed good consistency between the predicted values of the model and the ac-tual 28-day mortality rate.The decision curve suggested that the model had a good clinical net benefit within the threshold range of 0.01-0.99.Conclusion The nomogram model based on dynamic changes in serum PCT and hs-CRP(ΔPCT,Δhs-CRP),age≥60 years,and SOFA score has good predictive power for the 28-day survival prognosis of sepsis patients,and the model calibration and clinical practicality are both good.