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. 2023 Jul 7;23(1):230.
doi: 10.1186/s12871-023-02189-8.

Predictors and nomogram of in-hospital mortality in sepsis-induced myocardial injury: a retrospective cohort study

Kai-Zhi Xu  1 , Ping Xu  1 , Juan-Juan Li  1 , A-Fang Zuo  1 , Shu-Bao Wang  1 , Fang Han  2
Affiliations

Predictors and nomogram of in-hospital mortality in sepsis-induced myocardial injury: a retrospective cohort study

Kai-Zhi Xu et al. BMC Anesthesiol. .

Abstract

Background: Sepsis-induced myocardial injury (SIMI) is a common organ dysfunction and is associated with higher mortality in patients with sepsis. We aim to construct a nomogram prediction model to assess the 28-day mortality in patients with SIMI. .

Method: We retrospectively extracted data from Medical Information Mart for Intensive Care (MIMIC-IV) open-source clinical database. SIMI was defined by Troponin T (higher than the 99th percentile of upper reference limit value) and patients with cardiovascular disease were excluded. A prediction model was constructed in the training cohort by backward stepwise Cox proportional hazards regression model. The concordance index (C-index), area under the receiver operating characteristics curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration plotting and decision-curve analysis (DCA) were used to evaluate the nomogram.

Results: 1312 patients with sepsis were included in this study and 1037 (79%) of them presented with SIMI. The multivariate Cox regression analysis in all septic patients revealed that SIMI was independently associated with 28-day mortality of septic patients. The risk factors of diabetes, Apache II score, mechanical ventilation, vasoactive support, Troponin T and creatinine were included in the model and a nomogram was constructed based on the model. The C-index, AUC, NRI, IDI, calibration plotting and DCA showed that the performance of the nomogram was better than the single SOFA score and Troponin T.

Conclusion: SIMI is related to the 28-day mortality of septic patients. The nomogram is a well-performed tool to predict accurately the 28-day mortality in patients with SIMI.

Keywords: 28-day mortality; Nomogram; Sepsis; Sepsis-induced myocardial injury; Troponin T.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart
Fig. 2
Fig. 2
Nomogram for predicting the 28-day survival probability of patients with SIMI. When using it, drawing a vertical line from each variable upward to the points and then recording the corresponding points (i.e., “Vasoactive support = 1” =20 points). The point of each variable was then summed up to obtain a total score that corresponds to a predicted probability of 28-day survaval at the bottom of the nomogram
Fig. 3
Fig. 3
ROC curve and AUROC of Nomogram, SOFA score and Troponin T in training cohort (A) and validation cohort (B). The AUROC of nomogram is higher than that of SOFA and Troponin T in both cohorts
Fig. 4
Fig. 4
Calibration curves in training cohort (A) and validation cohort (B). In both cohorts, a good conformity between observation and prediction was observed
Fig. 5
Fig. 5
The DCA curve of medical intervention in patients with the Nomogram, SOFA score, and Troponin T in training cohort (A) and validation cohort (B)
See this image and copyright information in PMC

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