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. 2022 Sep 26:10:1006955.
doi: 10.3389/fpubh.2022.1006955. eCollection 2022.

Tree-based, two-stage risk factor analysis for postoperative sepsis based on Sepsis-3 criteria in elderly patients: A retrospective cohort study

Xiaorong Peng  1 , Chaojin Chen  1 , Jingjing Chen  2 , Yanlin Wang  1 , Duo Yang  3 , Chuzhou Ma  4 , Zifeng Liu  2 , Shaoli Zhou  1 , Ziqing Hei  1
Affiliations

Tree-based, two-stage risk factor analysis for postoperative sepsis based on Sepsis-3 criteria in elderly patients: A retrospective cohort study

Xiaorong Peng et al. Front Public Health. .

Abstract

Background: Sepsis remains the leading cause of postoperative death in elderly patients and is defined as organ dysfunction with proven or suspected infection according to Sepsis-3 criteria. To better avoid potential non-linear associations between the risk factors, we firstly used a tree-based analytic methods to explore the putative risk factors of geriatric sepsis based on the criteria in the study.

Methods: Data of 7,302 surgical patients aged ≥ 65 years at the Third Affiliated Hospital of Sun Yat-sen University from January 2015 to September 2020 were collected. An analytic method that combined tree-based analysis with the method of Mantel-Haenszel and logistic regression was adopted to assess the association between 17 putative risk factors and postoperative sepsis defined by the Sepsis-3 guideline by controlling 16 potential confounding factors.

Results: Among the 16 potential covariates, six major confounders were statistically identified by the tree-based model, including cerebrovascular diseases, preoperative infusion of red blood cells, pneumonia, age ≥ 75, malignant tumor and diabetes. Our analysis indicated that emergency surgery increases the risk of postoperative sepsis in elderly patients by more than six times. The type of surgery is also a crucial risk factor for sepsis, particularly transplantation and neurosurgery. Other risk factors were duration of surgery > 120 min, administration of steroids, hypoalbuminemia, elevated creatinine, blood urea nitrogen, hematocrit, platelets, glucose, white blood cell count, abnormal neutrophil-to-lymphocyte ratio and elevated hsCRP-to-albumin ratio.

Conclusions: Our study uses an effective method to explore some risk factors for postoperative sepsis in elderly by adjusting many potential confounders and it can provide information for intervention design.

Keywords: classification and regression tree; elderly; risk factors; sepsis; tree-based analysis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
STROBE flowchart of patient enrollment in this study.
Figure 2
Figure 2
Tree structure derived from all the potential confounding factors (Model 3).
Figure 3
Figure 3
Crude relative risks for pairwise nodes of the tree model.
See this image and copyright information in PMC

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