新生儿败血症风险预测模型的建立与验证

doi:10.3969/j.issn.1006-5725.2023.21.016

Abstract

Abstract:

Objective To establish a Nomogram predictive model for Neonatal Sepsis （NS） based on the general characteristics and initial complete blood count of neonates. Methods Retrospective analysis was conducted on the clinical data of newborns who were admitted for the first time to NICU and completed blood routine examination after admission in the MIMIC Ⅲ database. The LASSO?Logistic regression was used to investigate the prediction factors of NS， and then Nomogram prediction model was established. Internal validation was performed using bootstrap resampling with 1000 iterations. External validation of the model was performed using the data from newborns admitted to the First Affiliated Hospital of Zhengzhou University. We evaluated the predictive performance by Area Under the Receiver Operating Characteristic Curve （AUROC）， C?index， calibration curve， and decision curve analysis （DCA）. Results Among the 3，001 neonates， 185 were diagnosed with NS. The Nomogram model was constructed based on indicators such as respiratory distress syndrome， gestational age， birthweight， and initial hematological parameters （red blood cell count， white blood cell count， lymphocyte percentage， neutrophil percentage）， exhibiting good predictive performance with an AUROC of 0.860. Satisfactory predictive abilities were confirmed through both internal and external validation. Conclusion This study developed and validated a well?performing Nomogram prediction model. With simple parameters， it can help clinicians identify newborns at high risk early.

Key words: neonatal Sepsis, Nomogram, complete Blood Count

CLC Number:

R722

Linan GAO,Pengkun YANG,Wenjun CAO,Qian ZHANG. Development and Validation of a Predictive Model for Neonatal Sepsis[J]. The Journal of Practical Medicine, 2023, 39(21): 2789-2795.

Figures/Tables 6

Tab.1

Comparison of data in neonates between NS group and non-NS group"

预测因素	总人数（n = 3 001）	非NS组（n = 2 816）	NS组（n = 185）	F/χ ² 值	P值
性别［例（%）］				1.148	0.284
男	1 687（56.21）	1 576（55.97）	111（60.00）
女	1 314（13.79）	1 240（44.03）	74（40.00）
呼吸窘迫综合征［例（%）］	1 056（35.19）	907（32.21）	149（80.54）	177.808	< 0.001
种族［例（%）］				5.624	0.131
白种人	2 027（67.54）	1 907（67.72）	120（64.86）
黄种人	225（7.50）	217（7.71）	8（4.32）
黑种人	331（11.02）	305（10.83）	26（14.05）
其他	418（13.93）	387（13.74）	31（16.76）
胎龄［例（%）］				391.300	< 0.001
胎龄 < 28周	459（15.29）	338（12.00）	121（65.41）
28周 ≤ 胎龄 < 32周	536（17.86）	508（18.04）	28（15.14）
32周 ≤ 胎龄 < 37周	1 381（46.02）	1 360（48.30）	21（11.35）
胎龄 ≥ 37周	625（20.83）	610（21.66）	15（8.11）
出生体质量（x ± s，kg）	2.23 ± 0.90	2.29 ± 0.87	1.31 ± 0.82	14.845	< 0.001
白细胞计数［例（%）］				81.453	< 0.001
白细胞计数 < 5 × 10⁹/L	167（5.56）	130（4.61）	37（20.00）
5 × 10⁹/L ≤ 白细胞计数 < 15 × 10⁹/L	1925（64.15）	1815（64.45）	110（59.46）
15 × 10⁹/L ≤ 白细胞计数 < 25 × 10⁹/L	772（25.72）	742（26.35）	30（16.22）
白细胞计数 ≥ 25 × 10⁹/L	137（4.57）	129（4.58）	8（4.32）
红细胞计数（x ± s，× 10¹²/L）	4.42 ± 0.67	4.45 ± 0.66	3.93 ± 0.68	10.336	< 0.001
血小板计数（x ± s，× 10⁹/L）	269.89 ± 88.87	271.40 ± 87.18	247.04 ± 109.26	3.618	0.003
淋巴细胞百分比（x ± s，%）	47.28 ± 19.87	46.83 ± 19.76	54.11 ± 20.26	-4.852	< 0.001
中性粒细胞百分比（x ± s，%）	39.96 ± 19.23	40.61 ± 19.12	30.02 ± 18.12	7.321	< 0.001
NLR［M（P₂₅，P₇₅）］	0.79（0.39，1.81）	0.81（0.41，1.84）	0.49（0.23，1.02）	-6.290	< 0.001
PLR［M（P₂₅，P₇₅）］	53.25（38.20， 74.21）	53.17（38.05， 73.77）	55.99（39.96，83.86）	1.595	0.111

Tab.1

Fig.1

Tab.2

Fig.2

Fig.3

Fig.4

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变量	OR值	95%CI	SE	β	P值
呼吸窘迫综合征	2.293	1.433~3.733	0.244	0.830	< 0.001
28周 ≤ 胎龄 < 32周	0.259	0.163~0.400	0.228	-1.352	< 0.001
32周 ≤ 胎龄 < 37周	0.216	0.125~0.361	0.268	-1.531	< 0.001
出生体质量	0.435	0.320~0.582	0.152	-0.832	< 0.001
15 × 10⁹/L ≤ 白细胞计数 < 25 × 10⁹/L	1.687	1.001~2.812	0.264	0.523	0.047
红细胞计数	0.645	0.492~0.875	0.147	-0.424	0.003
淋巴细胞百分比	0.959	0.941~0.978	0.009	-0.041	< 0.001
中性粒细胞百分比	0.942	0.922~0.963	0.011	-0.060	< 0.001

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Development and Validation of a Predictive Model for Neonatal Sepsis

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