Data_Sheet_1_Effects of growth trajectory of shock index within 24 h on the prognosis of patients with sepsis.docx

BackgroundSepsis is a serious disease with high clinical morbidity and mortality. Despite the tremendous advances in medicine and nursing, treatment of sepsis remains a huge challenge. Our purpose was to explore the effects of shock index (SI) trajectory changes on the prognosis of patients within 24 h after the diagnosis of sepsis.MethodsThis study was based on Medical Information Mart for Intensive Care IV (MIMIC- IV). The effects of SI on the prognosis of patients with sepsis were investigated using C-index and restricted cubic spline (RCS). The trajectory of SI in 24 h after sepsis diagnosis was classified by latent growth mixture modeling (LGMM). Cox proportional hazard model, double robust analysis, and subgroup analysis were conducted to investigate the influence of SI trajectory on in-hospital death and secondary outcomes.ResultsA total of 19,869 patients were eventually enrolled in this study. C-index showed that SI had a prognostic value independent of Sequential Organ Failure Assessment for patients with sepsis. Moreover, the results of RCS showed that SI was a prognostic risk factor. LGMM divided SI trajectory into seven classes, and patients with sepsis in different classes had notable differences in prognosis. Compared with the SI continuously at a low level of 0.6, the SI continued to be at a level higher than 1.0, and the patients in the class whose initial SI was at a high level of 1.2 and then declined had a worse prognosis. Furthermore, the trajectory of SI had a higher prognostic value than the initial SI.ConclusionBoth initial SI and trajectory of SI were found to be independent factors that affect the prognosis of patients with sepsis. Therefore, in clinical treatment, we should closely monitor the basic vital signs of patients and arrive at appropriate clinical decisions on basis of their change trajectory.

背景：败血症是一种临床病死率与发病率均较高的严重疾病。尽管医学与护理领域取得了巨大进步，败血症的治疗仍是一项重大挑战。本研究旨在探讨休克指数（SI）轨迹变化对败血症患者在诊断后24小时内预后的影响。方法：本研究基于重症监护医学信息市场第四版（MIMIC-IV）。通过C-index和限制性三次样条（RCS）分析，研究了SI对败血症患者预后的影响。败血症诊断后24小时内SI的轨迹通过潜在增长混合模型（LGMM）进行分类。采用Cox比例风险模型、双重稳健分析和亚组分析，探究SI轨迹对住院死亡和次要结果的影响。结果：共纳入19,869名患者。C-index表明，SI具有独立于序贯器官衰竭评估（SOFA）的预后价值。此外，RCS分析结果显示，SI是一个预后风险因素。LGMM将SI轨迹分为七类，不同类别的败血症患者在预后方面存在显著差异。与持续处于低水平0.6的SI相比，持续处于高于1.0水平的SI，以及初始SI处于高水平1.2后下降的患者，预后更差。此外，SI的轨迹比初始SI具有更高的预后价值。结论：研究发现在败血症患者的预后中，初始SI及其轨迹均为独立影响因素。因此，在临床治疗中，应密切监测患者的基本生命体征，并根据其变化轨迹做出适当的临床决策。