A prognostic model for patients was established based on negative fluid balance during septic shock treatment

ZHANG Zhen; WANG Donghao; LYU Yang

doi:10.3969/j.issn.1006-5725.2025.11.012

Abstract：Objective To determine the predictive power of negative fluid balance in the risk of death in septic shock patients after fluid resuscitation therapy.Methods The medical records of patients with septic shock admitted to the Intensive Care Department of Tianjin Medical University Cancer Hospital from March 2022 to December 2024 were retrospectively collected,and the final outcome was defined as death within 28 days during hospitalization.The study objects were randomly divided into the training set and the validation set,and then the model was built by Logistic regression method,and the nomogram and receiver operating characteristic curve(ROC curve)were drawn.Hosmer-Lemeshow test was used to evaluate the calibration degree of the prediction model,and the calibration curve was drawn to evaluate the differentiation degree of the prediction model.Decision curve analysis(DCA)was used to test the efficiency of the prediction model.Results A total of 286 patients with septic shock were included in the study,including 200 in the training set and 86 in the verification set,which were comparable.Multivariate Logistic regression analysis showed that negative fluid balance,APACHE II score and SOFA score were independent risk factors for poor survival and prognosis of ICU septic shock patients(all P<0.05).Based on the results of multivariate Logistic regression analysis,a nomogram was constructed to predict the survival and prognosis of patients with septic shock in ICU.In the training set and validation set,the area under the curve(AUC)of the ROC curve prediction model was 0.83(95%CI:0.73～0.93)and 0.83(95%CI:0.66～1.00),respectively.Hosmer-Lemeshow calibration curve has a good fit(training set P=0.169;The verification set P=1.000)is not significant.DCA showed that when the threshold probability of patients was 0.05～0.70,it was more beneficial to use the nomogram prediction model to predict the risk of death in septic shock patients.Conclusion Negative fluid balance after fluid resuscitation is associated with survival and prognosis of patients with septic shock.The predictive model of mortality risk of patients with septic shock was established by combining APACHEⅡ score and SOFA score,which has good predictive ability and clinical practicability.