中国实用儿科杂志

中国实用儿科杂志 ›› 2024, Vol. 39 ›› Issue (2): 119-124.DOI: 10.19538/j.ek2024020609

• 论著 • 上一篇    下一篇

先天性心脏病术后脓毒症患儿列线图预后模型的构建与验证

  

  1. 1.南方医科大学附属广东省人民医院（广东省医学科学院）a 儿科重症监护室，b 先心病外科，广东  广州  510080；2.阳江市人民医院，广东  阳江  529500
  • 出版日期:2024-02-06 发布日期:2024-02-26
  • 通讯作者: 郭予雄，电子信箱：363977590@qq.com
  • 基金资助:
    国家重点研发计划项目（2020YFC1107904，2022YFC2407406）

Construction and validation of a predictive model for patients with sepsis after congenital heart disease surgery

  1. *Departmen of Pediatric Intensive Care Unit，Guangdong Provincial People′s Hospital（Guangdong Academy of Medical Sciences），Southern Medical University，Guangzhou  510080，China
  • Online:2024-02-06 Published:2024-02-26

摘要： 目的    探讨先天性心脏病术后脓毒症患儿死亡的预测因素，并建立列线图预测模型。方法     收集2012年1月至2021年12月广东省人民医院开胸手术的先天性心脏病术后脓毒症患儿临床数据。采用单因素、多因素Logistic回归分析，筛选出先天性心脏病术后脓毒症患儿死亡危险因素，根据筛选结果建立列线图预测模型，使用Bootstrap重抽样法进行内部验证。结果    共纳入157例，存活组135例患儿，死亡组22例。经单因素分析和多因素Logistics回归分析发现，术后发热总时间（OR=1.084，95% CI：1.022～1.151）、术后第3天血管活性-正性肌力评分（OR=1.162，95% CI：1.070～1.263）、二次开胸（OR=6.033，95% CI：1.906～19.098）是先天性心脏病术后脓毒症患儿死亡的独立危险因素（P<0.05）。以上述3项危险因素建立列线图预测模型，受试者工作特征曲线下面积为0.909（95% CI：0.852～0.966），重复抽样法验证的区分度C指数：0.9139（95% CI：0.9100～0.9178）；Hosmer-Lemeshow拟合优度检验显示，该模型预测先天性心脏病术后脓毒症患儿死亡风险的一致性良好（χ2=7.617，P=0.472）。结论    术后发热总时间、术后第3天血管活性-正性肌力评分、二次开胸是先天性心脏病术后脓毒症患儿死亡的独立危险因素；根据危险因素构建并验证了列线图预测模型，为先天性心脏病术后脓毒症患儿提供生存结局预测。

关键词: 先天性心脏病, 手术, 脓毒症, 死亡因素, 列线图

Abstract: To investigate the predictive factors of death in patients with sepsis after congenital heart disease surgery，and establish a nomogram prediction model. Methods    The clinical data of children who developed sepsis after cardiopulmonary bypass thoracotomy at Guangdong Provincial People's Hospital between January 2012 and December 2021 were collected. Univariate and multivariate logistic regression analysis was conducted to identify the risk factors associated with mortality in children with sepsis after congenital heart disease. Based on the results of the analysis，a nomogram prediction model was developed and the Bootstrap resampling method was used for internal verification. Results    A total of 157 children were included in the study，with 135 survivors and 22 deaths. Univariate analysis and multivariate logistic regression analysis revealed several independent risk factors for death in children with sepsis after congenital heart disease  surgery.These factors included the total time of postoperative fever （OR=1.084，95% CI 1.022-1.151），asoactive-inotropic score on the third day after surgery （OR=1.162，95% CI 1.070-1.263），and secondary thoracotomy （OR = 6.033，95%CI 1.906  -19.098）. Based on the above-mentioned three indepe-ndent risk factors，a nomogram prediction model was developed with an area under curve of  0.909（95% CI：0.852  -0.966）.  The identification C index of the Bootstrap resampling method was 0.9139（95%CI 0.9100-0.9178）. The Hosmer-Lemeshow goodness of fit test demonstrated that the nomogram model accurately predicted the risk of death in children with sepsis after surgery （χ2=7.617，P=0.472）. Conclusion    The duration of postoperative fever，vasoactive-inotropic score on the third day after surgery，and secondary thoracotomy are independent risk factors for death of children with sepsis after congenital heart disease surgery. Based on the risk factors，the nomogram prediction model is successfully constructed and verified to predict the survival outcome of sepsis patients with congenital heart disease after surgery.

Key words: congenital heart disease, operation, sepsis, death factors, nomogram