目的 明确脓毒性休克患者在液体复苏治疗后液体负平衡量对脓毒性休克患者死亡风险中的预测能力。 方法 回顾性收集2022年3月至2024年12月在天津医科大学肿瘤医院重症监护科收治的脓毒性休克患者的病历资料，最终结局定义为住院期间28 d内死亡。将研究对象随机分为训练集和验证集，然后采用logistic回归法建模，并绘制列线图，绘制受试者工作特征曲线（ROC曲线），利用Hosmer-Lemeshow检验评价预测模型的校准度，并绘制校准曲线，评估预测模型的区分度，用决策曲线分析（DCA）对预测模型的效能进行测试。 结果 研究共纳入286例脓毒性休克患者，其中训练集200例、验证集86例，二者具有可比性。多因素logistic回归分析显示，液体负平衡量、APACHE Ⅱ评分、SOFA评分是ICU脓毒性休克患者不良生存预后的独立危险因素（均P < 0.05）。根据多因素logistic回归分析结果构建列线图，用于临床预测ICU脓毒性休克患者的生存预后。在训练集和验证集中，ROC曲线预测模型的曲线下面积（AUC）分别为0.83（95%CI：0.73 ~ 0.93）和0.83（95%CI：0.66 ~ 1.00），Hosmer-Lemeshow校准曲线拟合度较好（训练集P = 0.169；验证集P = 1.000），不具有显著性。DCA显示当患者的阈值概率为0.05 ~ 0.7时，使用列线图预测模型预测脓毒性休克患者死亡风险更有益。 结论 脓毒性休克患者液体复苏后液体负平衡量与患者的生存预后相关，联合APACHEⅡ评分、SOFA评分建立脓毒性休克患者死亡风险的预测模型，具有良好的预测能力和临床实用性。

Objective To determine the predictive power of negative fluid balance in the risk of death in septic shock patients after fluid resuscitation therapy. Methods The medical records of patients with septic shock admitted to the Intensive Care Department of Tianjin Medical University Cancer Hospital from March 2022 to December 2024 were retrospectively collected， and the final outcome was defined as death within 28 days during hospitalization. The study objects were randomly divided into the training set and the validation set， and then the model was built by Logistic regression method， and the nomogram and receiver operating characteristic curve （ROC curve） were drawn. Hosmer-Lemeshow test was used to evaluate the calibration degree of the prediction model， and the calibration curve was drawn to evaluate the differentiation degree of the prediction model. Decision curve analysis （DCA） was used to test the efficiency of the prediction model. Results A total of 286 patients with septic shock were included in the study， including 200 in the training set and 86 in the verification set， which were comparable. Multivariate Logistic regression analysis showed that negative fluid balance， APACHE II score and SOFA score were independent risk factors for poor survival and prognosis of ICU septic shock patients （all P < 0.05）. Based on the results of multivariate Logistic regression analysis， a nomogram was constructed to predict the survival and prognosis of patients with septic shock in ICU. In the training set and validation set， the area under the curve （AUC） of the ROC curve prediction model was 0.83 （95%CI：0.73 ~ 0.93） and 0.83 （95%CI：0.66 ~ 1.00）， respectively. Hosmer-Lemeshow calibration curve has a good fit （training set P= 0.169； The verification set P = 1.000） is not significant. DCA showed that when the threshold probability of patients was 0.05~0.70， it was more beneficial to use the nomogram prediction model to predict the risk of death in septic shock patients. Conclusion Negative fluid balance after fluid resuscitation is associated with survival and prognosis of patients with septic shock. The predictive model of mortality risk of patients with septic shock was established by combining APACHEⅡ score and SOFA score， which has good predictive ability and clinical practicability.