Objective: To investigate the predictive value of the joint prediction model based on the modified systemic inflammatory response syndrome (SIRS) score (hereinafter referred to as the joint prediction model) for the mortality risk of patients with large area burns within 24 hours after admission. Methods: The clinical data of 158 patients [111 males, 47 females, aged 40 (28, 50) years] admitted to the Department of Burn Surgery of the First Affiliated Hospital of Naval Medical University from January 2005 to January 2018, conforming to the study criteria, were analyzed retrospectively by the method of case-control study. The age, gender, total burn area, full-thickness burn area, injury cause, with or without inhalation injury, severity of inhalation injury, and tracheotomy condition of patients were recorded, and the modified SIRS score and the modified Baux score of patients were calculated. According to the final outcome, all patients were divided into survival group (n=123) and death group (n=35). The clinical data of patients between two groups, except for modified Baux score, were compared by chi-square test or Mann-Whitney U test to screen the death-related factors of patients. The indexes with statistically significant difference between the two groups were included in the multivariate logistic regression analysis to screen the independent risk factors related to the death of patients, and the prediction model was constructed by combining the modified SIRS score. The receiver's operating characteristic curves of the modified SIRS score, the modified Baux score, and the joint prediction model of 158 patients were drawn to analyze their ability to predict death of patients. The area under curve (AUC) of the receiver's operating characteristic and the sensitivity and specificity of optimal threshold were calculated, and the quality of AUC of the three prediction indexes was compared with Jonckheere-Terpstra test. Results: (1) There were statistically significant differences between the two groups in the modified SIRS score, age, total burn area, full-thickness burn area, severity of inhalation injury, with or without inhalation injury, and tracheotomy condition of patients (Z=-4.356, -3.568, -5.291, -6.052, -4.720, χ(2)=12.967, 19.692, P<0.01). (2) The modified SIRS score, age, full-thickness burn area were the independent risk factors for the death of patients with large area burn (odds ratio=2.699, 1.069, 1.029, 95% confidence interval=1.447-5.033, 1.029-1.109, 1.005-1.054, P<0.05). (3) The AUC of modified SIRS score, the joint prediction model, and the modified Baux score for predicting death of 158 patients within 24 hours after admission were 0.730, 0.879, and 0.895 respectively (95% confidence interval=0.653-0.797, 0.818-0.926, 0.836-0.938, P<0.01). The sensitivities of the three optimal threshold values to death prediction were 54.3%, 91.4%, and 82.9% respectively, while the specificities were 81.3%, 76.4%, and 84.6% respectively. The AUC quality of the joint prediction model was similar to that of the modified Baux score (95% confidence interval=-0.057-0.088, P>0.05), and both of them were significantly better than that of the modified SIRS score (95% confidence interval=0.072-0.259, 0.023-0.276, P<0.05 or P<0.01). Conclusions: Both the joint prediction model and the modified Baux score are considered to be good to predict the death rate of patients with large area burns at early stage after admission. However, the joint prediction model has better clinical practice value due to its advantage of simple scoring and easier access to data acquisition.
目的： 探索基于改良全身炎症反应综合征(SIRS)评分建立的联合预测模型(下称联合预测模型)对大面积烧伤患者入院24 h内死亡风险的预测价值。 方法： 海军军医大学第一附属医院烧伤外科2005年1月—2018年1月收治符合入选标准的大面积烧伤患者158例，其中男111例、女47例，年龄40(28，50)岁，以病例对照研究的方法回顾性分析其临床资料。统计患者的年龄、性别、烧伤总面积、Ⅲ度烧伤面积、致伤原因、有无吸入性损伤、吸入性损伤严重程度、气管切开情况，计算患者的改良SIRS评分、修正Baux评分。根据最终结局，将患者分为存活组123例和死亡组35例，使用χ(2)检验或Mann－Whitney U检验比较2组患者除修正Baux评分外的其他临床资料，筛选出患者死亡的相关因素。将2组比较差异有统计学意义的指标纳入多因素logistic回归分析，筛选出与患者死亡相关的独立危险因素，并联合改良SIRS评分构建预测模型。绘制158例患者改良SIRS评分、修正Baux评分与联合预测模型的受试者工作特征曲线，分析三者对患者死亡的预测性能，计算受试者工作特征曲线下面积(AUC)以及最佳阈值下的敏感度、特异度，采用Jonckheere－Terpstra检验对3种预测指标AUC的质量进行比较。 结果： (1)2组患者在改良SIRS评分、年龄、烧伤总面积、Ⅲ度烧伤面积、吸入性损伤严重程度及有无吸入性损伤、气管切开情况方面比较，差异有统计学意义(Z＝－4.356、－3.568、－5.291、－6.052、－4.720，χ(2)＝12.967、19.692，P<0.01)。(2)改良SIRS评分、年龄、Ⅲ度烧伤面积是大面积烧伤患者死亡的独立危险因素(比值比＝2.699、1.069、1.029，95%置信区间＝1.447～5.033、1.029～1.109、1.005～1.054，P<0.05)。(3)对158例患者入院24 h内死亡预测的改良SIRS评分、修正Baux评分、联合预测模型的受试者工作特征AUC分别为0.730、0.879、0.895(95%置信区间＝0.653～0.797、0.818～0.926、0.836～0.938，P<0.01)，三者的最佳阈值下对死亡预测的敏感度分别为54.3%、91.4%、82.9%，特异度分别为81.3%、76.4%、84.6%。联合预测模型与修正Baux评分的AUC质量相近(95%置信区间＝－0.057～0.088，P>0.05)，均明显优于改良SIRS评分(95%置信区间＝0.072～0.259、0.023～0.276，P<0.05或P<0.01)。 结论： 联合预测模型与修正Baux评分均对大面积烧伤患者入院早期病死率有较好的预测能力，其中联合预测模型有评分项目简单、数据获取较易的优势，临床应用价值较高。.
Keywords: Burns; Forecasting; Joint prediction model; Modified systemic inflammatory response syndrome score; Mortality risk; Systemic inflammatory response syndrome.