基于列线图的儿童脓毒症早期诊断模型的建立

Establishment of a nomogram model for the early diagnosis of childhood sepsis

摘要:

目的 建立儿童脓毒症早期诊断的列线图模型。 方法 回顾性选取2018年1月—2021年6月四川省妇幼保健院收治的76例儿童脓毒症患者为脓毒症组，根据性别、年龄（±2岁）进行1∶1∶1配对选择同期住院的局部感染患儿76例为局部感染组，非感染性疾病的76例患儿为对照组。比较3组患儿实验室指标、快速序贯器官衰竭评价（quick Sequential Organ Failure Assessment，qSOFA）评分与小儿危重病例评分法（Pediatric Critical Illness Score，PCIS）评分，并采用多因素logistic回归分析评估上述指标与脓毒症的关联，根据多因素分析结果采用R4.1.3软件构建脓毒症早期诊断的列线图模型并对模型进行验证。以受试者工作特征（receiver operating characteristic，ROC）曲线分析法评估该模型的价值，再以Bootstrap法对该模型进行内部验证。 结果 多因素logistic回归分析结果显示，可溶性髓样细胞触发受体-1、qSOFA评分、PCIS评分、C反应蛋白、白细胞介素-6及白细胞介素-10与儿童脓毒症独立相关（P<0.05）。将上述指标用于建立早期诊断脓毒症的列线图，ROC曲线下面积为0.837，95%CI为0.760~0.914，校准曲线结果显示平均绝对误差为0.024，模型表现与理想模型基本拟合。 结论 可溶性髓样细胞触发受体-1、qSOFA评分、PCIS评分、C反应蛋白、白细胞介素-6及白细胞介素-10与儿童脓毒症独立相关，以上述指标建立的列线图模型对儿童脓毒症的早期诊断具有较高的区分度与准确度。

Abstract:

Objective To establish a nomogram model for the early diagnosis of sepsis in children. Methods A total of 76 children with sepsis who were admitted to Sichuan Maternal and Child Health Hospital from January 2018 to June 2021 were retrospectively selected as the sepsis group. After matching for sex and age (±2 years) at a ratio of 1:1:1, 76 children with local infection who were hospitalized during the same period were enrolled as the local infection group, and 76 children with non-infectious diseases were enrolled as the control group. The three groups were compared in terms of laboratory markers and the results of quick Sequential Organ Failure Assessment (qSOFA) and Pediatric Critical Illness Score (PCIS). A multivariate logistic regression analysis was used to investigate the association between the above indicators and sepsis. R4.1.3 software was used to establish and validate the nomogram model for the early diagnosis of sepsis based on the results of the multivariate analysis. A receiver operating characteristic (ROC) curve analysis was used to evaluate the value of the nomogram model, and the Bootstrap method was used to perform the internal validation of the model. Results The multivariate logistic regression analysis showed that soluble triggering receptor expressed on myeloid cells-1, qSOFA score, PCIS score, C-reactive protein, interleukin-6, and interleukin-10 were independently associated with childhood sepsis (P<0.05). The above indicators were used to establish a nomogram for the early diagnosis of sepsis, with an area under the ROC curve of 0.837 (95%CI: 0.760-0.914), and the calibration curve results showed a mean absolute error of 0.024, suggesting that the performance of this model was basically consistent with that of the ideal model. Conclusions The indicators soluble triggering receptor expressed on myeloid cells-1, qSOFA score, PCIS score, C-reactive protein, interleukin-6, and interleukin-10 are independently associated with childhood sepsis, and the nomogram model established based on these indicators has high discriminatory ability and accuracy in the early diagnosis of sepsis in children.