Objective:To investigate the predictive value of controlling nutritional status(CONUT)score for progression to chronic critical illness sepsis in elderly patients,and to construct a predictive model based on CONUT sco...Objective:To investigate the predictive value of controlling nutritional status(CONUT)score for progression to chronic critical illness sepsis in elderly patients,and to construct a predictive model based on CONUT score histogram.Methods:739 elderly patients with sepsis admitted from January 2020 to December 2022 were selected as the study objects,and were divided into chronic critical illness group(n=188)and non-chronic critical illness group(n=551)according to whether chronic critical illness disease occurred.Clinical data of the patients were collected and compared.The predictive value of CONUT score,PNI and NLR in the progression of senile sepsis to chronic severe disease was compared,and the optimal threshold value was determined,which was used to convert the numerical variables into binary variables.Through univariate analysis and multivariate Logistic regression analysis,the risk factors affecting the progression of elderly sepsis patients to chronic critical illness disease were screened out,and the prediction model was built based on the nomogram.The efficacy and clinical utility of the prediction model were evaluated by the area under the ROC curve(AUC),calibration curve and decision curve analysis(DCA).Results:The best cut-off value for CONUT score in predicting elderly sepsis progressing to chronic critical illness was 4 points.The predictive performance of CONUT score(AUC=0.739)was better than that of PNI(AUC=0.609)and NLR(AUC=0.582)in elderly sepsis progressing to chronic critical illness(CONUT score vs PNI:Z=5.960,P<0.001;CONUT score vs NLR:Z=6.119,P<0.001).Univariate analysis showed that age,CCI score,SOFA score,sepsis shock,serum Lac,CONUT score,mechanical ventilation(MV),and continuous renal replacement therapy(CRRT)treatment were related to elderly sepsis progressing to chronic critical illness(P<0.05).Multivariate logistic regression analysis showed that CONUT score≥4 points,age≥75 years,CCI score≥3 points,SOFA score>5 points,sepsis shock,and serum Lac≥4 mmol/L were independent risk factors for elderly sepsis progressing to chronic critical illness(P<0.05).The nomogram showed that CONUT score had the greatest contribution value in predicting elderly sepsis progressing to chronic critical illness.Based on this,the nomogram prediction model had an AUC of 0.846[95%CI(0.812~0.879)],with a sensitivity of 75.5%and specificity of 81.3%,indicating good predictive performance.The calibration curve was close to the ideal curve,and the DCA threshold had clinical utility advantages when ranging from 0.1 to 0.9.Conclusion:The nomographic prediction model based on CONUT score can effectively predict the risk probability of senile sepsis progressing to chronic critical illness,helpful for clinicians to identify the high risk group of chronic and severe senile sepsis,which is helpful for clinicians to identify high-risk populations of elderly sepsis with chronic critical illness.展开更多
目的:探索控制营养状况(Controlling Nutritional Status,CONUT)评分、WPCBAL评分、预后营养指数(Prognostic Nutritional Index,PNI)等3种预后评分系统对晚期肺癌患者生存时间的预测效能。方法:收集2018年12月—2021年12月在山东省第...目的:探索控制营养状况(Controlling Nutritional Status,CONUT)评分、WPCBAL评分、预后营养指数(Prognostic Nutritional Index,PNI)等3种预后评分系统对晚期肺癌患者生存时间的预测效能。方法:收集2018年12月—2021年12月在山东省第一医科大学附属肿瘤医院住院期间发生死亡,且具有评估所需全部数据的138例晚期肺癌患者的相关资料,进行回顾性分析。3个评分系统不同组别人群生存期差异的比较采用Log-rank检验,评估系统对终末期肺癌患者2周生存期的预测效能用受试者工作特征(ROC)曲线进行评价。结果:138例终末期肺癌患者的中位年龄为63.5岁,末次入院的中位生存时间为14 d,2周死亡率为51.4%。Log-rank检验结果显示,CONUT≥5分组的生存时间比CONUT<5分组更短,差异有统计学意义(11 d vs 16 d,P=0.046);WPCBAL≥5分组的生存时间比WPCBAL<5分组更短,差异有统计学意义(8 d vs 16 d,P=0.002)。ROC曲线显示,CONUT、WPCBAL对晚期肺癌患者2周生存状态的预测有一定价值,ROC曲线下面积分别为0.613、0.677。CONUT评分以5为截点时,预测晚期肺癌患者2周生存期的灵敏度、特异度分别为0.61、0.54;WPCBAL评分以5为截点时,预测晚期肺癌患者2周生存期的灵敏度、特异度分别为0.76、0.54。结论:CONUT评分、WPCBAL评分对预测晚期肺癌患者短期生存状态有一定价值,但特异度相对较低,仍需进一步研究。展开更多
目的评价术前CONUT评分在接受手术治疗的胃癌患者中的预后价值。方法计算机检索PubMed、Web of Science、Embase、Cochrane图书馆、中国期刊全文数据库(CNKI)、万方数据库等数据库,纳入关于术前CONUT评分与接受手术治疗胃癌患者预后的...目的评价术前CONUT评分在接受手术治疗的胃癌患者中的预后价值。方法计算机检索PubMed、Web of Science、Embase、Cochrane图书馆、中国期刊全文数据库(CNKI)、万方数据库等数据库,纳入关于术前CONUT评分与接受手术治疗胃癌患者预后的相关研究,检索时间为建库至2018年10月。按照纳入与排除标准筛选文献,提取数据并进行质量评价,采用Stata 12.0软件进行Meta分析。结果共纳入5篇英文文献,包含1822例Ⅰ~Ⅳ期胃癌患者。分析结果表明,术前CONUT评分与胃癌患者的总生存期(OS)显著相关,评分越高患者OS越短,差异有统计学意义(HR:1.71,95%CI:1.03~2.85,P=0.038)。亚组分析显示:在中国和截止值为3的研究中,术前CONUT评分与胃癌患者的OS明显缩短(中国,HR:1.44,95%CI:1.13~1.84,P=0.003;截止值为3,HR:3.27,95%CI:1.96~5.48,P<0.001)。但在日本和截止值不为3的研究中,术前CONUT评分与胃癌患者的OS无明显相关性(日本,HR:2.05,95%CI:0.68~6.18,P=0.203;截止值不为3,HR:1.16,95%CI:0.75~1.80,P=0.491)。结论术前CONUT评分与接受手术治疗胃癌患者的OS明显相关,可作为胃癌术后预后评估的潜在标记物。展开更多
基金Natural Science Foundation of Hainan Provincial(No.819MS128)。
文摘Objective:To investigate the predictive value of controlling nutritional status(CONUT)score for progression to chronic critical illness sepsis in elderly patients,and to construct a predictive model based on CONUT score histogram.Methods:739 elderly patients with sepsis admitted from January 2020 to December 2022 were selected as the study objects,and were divided into chronic critical illness group(n=188)and non-chronic critical illness group(n=551)according to whether chronic critical illness disease occurred.Clinical data of the patients were collected and compared.The predictive value of CONUT score,PNI and NLR in the progression of senile sepsis to chronic severe disease was compared,and the optimal threshold value was determined,which was used to convert the numerical variables into binary variables.Through univariate analysis and multivariate Logistic regression analysis,the risk factors affecting the progression of elderly sepsis patients to chronic critical illness disease were screened out,and the prediction model was built based on the nomogram.The efficacy and clinical utility of the prediction model were evaluated by the area under the ROC curve(AUC),calibration curve and decision curve analysis(DCA).Results:The best cut-off value for CONUT score in predicting elderly sepsis progressing to chronic critical illness was 4 points.The predictive performance of CONUT score(AUC=0.739)was better than that of PNI(AUC=0.609)and NLR(AUC=0.582)in elderly sepsis progressing to chronic critical illness(CONUT score vs PNI:Z=5.960,P<0.001;CONUT score vs NLR:Z=6.119,P<0.001).Univariate analysis showed that age,CCI score,SOFA score,sepsis shock,serum Lac,CONUT score,mechanical ventilation(MV),and continuous renal replacement therapy(CRRT)treatment were related to elderly sepsis progressing to chronic critical illness(P<0.05).Multivariate logistic regression analysis showed that CONUT score≥4 points,age≥75 years,CCI score≥3 points,SOFA score>5 points,sepsis shock,and serum Lac≥4 mmol/L were independent risk factors for elderly sepsis progressing to chronic critical illness(P<0.05).The nomogram showed that CONUT score had the greatest contribution value in predicting elderly sepsis progressing to chronic critical illness.Based on this,the nomogram prediction model had an AUC of 0.846[95%CI(0.812~0.879)],with a sensitivity of 75.5%and specificity of 81.3%,indicating good predictive performance.The calibration curve was close to the ideal curve,and the DCA threshold had clinical utility advantages when ranging from 0.1 to 0.9.Conclusion:The nomographic prediction model based on CONUT score can effectively predict the risk probability of senile sepsis progressing to chronic critical illness,helpful for clinicians to identify the high risk group of chronic and severe senile sepsis,which is helpful for clinicians to identify high-risk populations of elderly sepsis with chronic critical illness.
文摘目的:探索控制营养状况(Controlling Nutritional Status,CONUT)评分、WPCBAL评分、预后营养指数(Prognostic Nutritional Index,PNI)等3种预后评分系统对晚期肺癌患者生存时间的预测效能。方法:收集2018年12月—2021年12月在山东省第一医科大学附属肿瘤医院住院期间发生死亡,且具有评估所需全部数据的138例晚期肺癌患者的相关资料,进行回顾性分析。3个评分系统不同组别人群生存期差异的比较采用Log-rank检验,评估系统对终末期肺癌患者2周生存期的预测效能用受试者工作特征(ROC)曲线进行评价。结果:138例终末期肺癌患者的中位年龄为63.5岁,末次入院的中位生存时间为14 d,2周死亡率为51.4%。Log-rank检验结果显示,CONUT≥5分组的生存时间比CONUT<5分组更短,差异有统计学意义(11 d vs 16 d,P=0.046);WPCBAL≥5分组的生存时间比WPCBAL<5分组更短,差异有统计学意义(8 d vs 16 d,P=0.002)。ROC曲线显示,CONUT、WPCBAL对晚期肺癌患者2周生存状态的预测有一定价值,ROC曲线下面积分别为0.613、0.677。CONUT评分以5为截点时,预测晚期肺癌患者2周生存期的灵敏度、特异度分别为0.61、0.54;WPCBAL评分以5为截点时,预测晚期肺癌患者2周生存期的灵敏度、特异度分别为0.76、0.54。结论:CONUT评分、WPCBAL评分对预测晚期肺癌患者短期生存状态有一定价值,但特异度相对较低,仍需进一步研究。
文摘目的评价术前CONUT评分在接受手术治疗的胃癌患者中的预后价值。方法计算机检索PubMed、Web of Science、Embase、Cochrane图书馆、中国期刊全文数据库(CNKI)、万方数据库等数据库,纳入关于术前CONUT评分与接受手术治疗胃癌患者预后的相关研究,检索时间为建库至2018年10月。按照纳入与排除标准筛选文献,提取数据并进行质量评价,采用Stata 12.0软件进行Meta分析。结果共纳入5篇英文文献,包含1822例Ⅰ~Ⅳ期胃癌患者。分析结果表明,术前CONUT评分与胃癌患者的总生存期(OS)显著相关,评分越高患者OS越短,差异有统计学意义(HR:1.71,95%CI:1.03~2.85,P=0.038)。亚组分析显示:在中国和截止值为3的研究中,术前CONUT评分与胃癌患者的OS明显缩短(中国,HR:1.44,95%CI:1.13~1.84,P=0.003;截止值为3,HR:3.27,95%CI:1.96~5.48,P<0.001)。但在日本和截止值不为3的研究中,术前CONUT评分与胃癌患者的OS无明显相关性(日本,HR:2.05,95%CI:0.68~6.18,P=0.203;截止值不为3,HR:1.16,95%CI:0.75~1.80,P=0.491)。结论术前CONUT评分与接受手术治疗胃癌患者的OS明显相关,可作为胃癌术后预后评估的潜在标记物。
文摘目的探讨控制营养状态(controlling nutritional score,CONUT)评分对重症急性胰腺炎(severe acute pancreatitis,SAP)的预测价值。方法回顾性收集郑州大学第一附属医院2024年1月至2024年12月共426例急性胰腺炎患者,根据排除标准,筛出189例纳入研究。根据诊断标准分类为非重症急性胰腺炎(non-severe acute pancreatitis,NSAP)组和SAP组。分别比较各组患者之间的年龄、性别、基础疾病、生命体征、CONUT评分、急性胰腺炎严重程度床边指数(bedside index for severity in acute pancreatitis,BISAP)评分等一般资料,以及入院时血常规、血糖、肝肾功、血凝、淀粉酶、脂肪酶等实验室检测指标。采用二元Logistic回归分析影响急性胰腺炎严重程度的危险因素,并绘制各指标的受试者工作特征(ROC)曲线,分别检测其ROC曲线下面积(AUC)、敏感度、特异度及最佳预测临界值以评估预测价值。结果SAP组患者住院天数、呼吸、PCT、CRP、中性粒细胞绝对值、谷草转氨酶、谷氨酰转肽酶、凝血酶原时间、D二聚体、国际标准化比值、纤维蛋白原、FDP、CONUT评分、SIRS评分、BISAP评分均高于NSAP组,且差异具有统计学意义(P<0.05)。而NSAP组红细胞计数、血红蛋白、淋巴细胞绝对值、Ca 2+、白蛋白、总胆固醇、凝血酶原时间活动度、PNI评分高于SAP组(P<0.05)。二元Logistic回归分析显示,CONUT评分(OR=1.623,95%CI:1.048~2.512)、BISAP评分(OR=19.608,95%CI:6.585~58.387)为AP患者病情严重程度的独立危险因素。CONUT评分、BISAP评分及2项联合预测SAP的AUC分别为0.694、0.815及0.864。结论CONUT评分是SAP的早期独立危险因素,其联合BISAP评分对AP的病情严重程度具有更好的预测价值。
