Voprosy kurortologii, fizioterapii, i lechebnoi fizicheskoi kultury · 2025
[Prognostic model of a patient with sepsis readiness to early mobilization with assistance].
СтатьяНаблюдательное исследованиеАннотация на английскомНазвание и аннотация: Перевод в очереди
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Ruslyakova I A, Shamsutdinova E Z, Shirokov K I, Ivanova N E
Аннотация
UNLABELLED: Management of the early rehabilitation (passive, assisted, active) risks will allow to minimize complications and increase safety of patients with sepsis.
OBJECTIVE: To develop a prognostic model of patient with sepsis readiness to early mobilization with assistance.
MATERIAL AND METHODS: A single-center retrospective cohort observational study with analysis of 780 electronic medical records of patients with sepsis from the «Intensive therapy of patients with severe community-acquired pneumonia» base of the North-Western State Medical University named after I. I. Mechnikov in the period from 2013 to 2022 was carried out. Statistical analysis by binary logistic regression method and ROC-analysis were performed using Jamovi 2.3.21 and IBM SPSS Statistics 26 softwares package.
RESULTS: The study includes the data of 519 patients with sepsis. Patients are divided into 2 study groups according to the score on the Intensive Care Unit Mobility Scale (IMS): IMS 0/1 (281 patients) and IMS ≥2 (238 patients). The predictors of IMS ≥2 for patients with sepsis have been determined: score on the APACHE II assessment scale of patient's state severity ≤20.0 (adjusted odds ratio (AOR) 6.38; 95% CI 3.01-13.5; p<0.001), score on the CCI Charlson comorbidity index ≤3.0 (AOR 3.84; 95% CI 1.72-8.58; p=0.001), score on the mNUTRIC critical state risk scale ≤5.0 (AOR 2.81; 95% CI 1.33-5.96; p=0.007), PO2/FiO2 index >119.0 mm Hg (AOR 104; 95% CI 29.59-365.6; p<0.001), albumin level >25.0 g/l (AOR 2.37; 95% CI 1.11-5.06; p=0.025). The prognostic model that considers 82.3% of factors determining the dispersion of IMS ≥2 probability has been developed. Area under ROC-curve amounted to 0.967±0.007 (95% CI 0.952-0.982). Sensitivity and specificity of IMS ≥2 prognostic model in patients with sepsis at 65% threshold were 92.0 and 92.6%, respectively, and accuracy - 92.3%.
CONCLUSION: The prognostic model of patient with sepsis readiness to early mobilization with assistance has been developed based on IMS ≥2 independent predictors. This model allows to use individual approach to early mobilization with assistance and identify patients who are ready to increase physical exertion without worsening clinical condition.
OBJECTIVE: To develop a prognostic model of patient with sepsis readiness to early mobilization with assistance.
MATERIAL AND METHODS: A single-center retrospective cohort observational study with analysis of 780 electronic medical records of patients with sepsis from the «Intensive therapy of patients with severe community-acquired pneumonia» base of the North-Western State Medical University named after I. I. Mechnikov in the period from 2013 to 2022 was carried out. Statistical analysis by binary logistic regression method and ROC-analysis were performed using Jamovi 2.3.21 and IBM SPSS Statistics 26 softwares package.
RESULTS: The study includes the data of 519 patients with sepsis. Patients are divided into 2 study groups according to the score on the Intensive Care Unit Mobility Scale (IMS): IMS 0/1 (281 patients) and IMS ≥2 (238 patients). The predictors of IMS ≥2 for patients with sepsis have been determined: score on the APACHE II assessment scale of patient's state severity ≤20.0 (adjusted odds ratio (AOR) 6.38; 95% CI 3.01-13.5; p<0.001), score on the CCI Charlson comorbidity index ≤3.0 (AOR 3.84; 95% CI 1.72-8.58; p=0.001), score on the mNUTRIC critical state risk scale ≤5.0 (AOR 2.81; 95% CI 1.33-5.96; p=0.007), PO2/FiO2 index >119.0 mm Hg (AOR 104; 95% CI 29.59-365.6; p<0.001), albumin level >25.0 g/l (AOR 2.37; 95% CI 1.11-5.06; p=0.025). The prognostic model that considers 82.3% of factors determining the dispersion of IMS ≥2 probability has been developed. Area under ROC-curve amounted to 0.967±0.007 (95% CI 0.952-0.982). Sensitivity and specificity of IMS ≥2 prognostic model in patients with sepsis at 65% threshold were 92.0 and 92.6%, respectively, and accuracy - 92.3%.
CONCLUSION: The prognostic model of patient with sepsis readiness to early mobilization with assistance has been developed based on IMS ≥2 independent predictors. This model allows to use individual approach to early mobilization with assistance and identify patients who are ready to increase physical exertion without worsening clinical condition.