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. 2023 Nov;35(11):2593-2601.
doi: 10.1007/s40520-023-02544-2. Epub 2023 Sep 5.

Predictive nomogram for in-hospital mortality among older patients with intra-abdominal sepsis incorporating skeletal muscle mass

Qiujing Li #  1 , Na Shang #  2 , Tiecheng Yang  1 , Qian Gao  1 , Shubin Guo  3
Affiliations

Predictive nomogram for in-hospital mortality among older patients with intra-abdominal sepsis incorporating skeletal muscle mass

Qiujing Li et al. Aging Clin Exp Res. 2023 Nov.

Abstract

Background: Studies on prognostic factors for older patients with intra-abdominal sepsis are scarce, and the association between skeletal muscle mass and prognosis among such patients remains unclear.

Aims: To develop a nomogram to predict in-hospital mortality among older patients with intra-abdominal sepsis.

Methods: Older patients with intra-abdominal sepsis were prospectively recruited. Their demographics, clinical features, laboratory results, abdominal computed tomography-derived muscle mass, and in-hospital mortality were recorded. The predictors of mortality were selected via least absolute shrinkage and selection operator and multivariable logistic regression analyses, and a nomogram was developed. The nomogram was assessed and compared with Sequential Organ Failure Assessment score, Acute Physiology and Chronic Health Evaluation II score, and Simplified Acute Physiology Score II.

Results: In total, 464 patients were included, of whom 104 (22.4%) died. Six independent risk factors (skeletal muscle index, cognitive impairment, frailty, heart rate, red blood cell distribution width, and blood urea nitrogen) were incorporated into the nomogram. The Hosmer-Lemeshow goodness-of-fit test and calibration plot revealed a good consistency between the predicted and observed probabilities. The area under the receiver operating characteristic curve was 0.875 (95% confidence interval = 0.838-0.912), which was significantly higher than those of commonly used scoring systems. The decision curve analysis indicated the nomogram had good predictive performance.

Discussion: Our nomogram, which is predictive of in-hospital mortality among older patients with intra-abdominal sepsis, incorporates muscle mass, a factor that warrants consideration by clinicians. The model has a high prognostic ability and might be applied in clinical practice after external validation.

Keywords: Intra-abdominal sepsis; Mortality; Nomogram; Older adults; Sarcopenia.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Flowchart of the study cohort
Fig. 2
Fig. 2
(a) Nomogram for predicting in-hospital mortality in older patients with intra-abdominal sepsis. (b) Calibration plot for the nomogram
Fig. 3
Fig. 3
Comparison of the nomogram and commonly used scoring systems. (a) ROC curves; (b) decision curve analysis
See this image and copyright information in PMC

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