Prognosis and influencing factors of patients with sepsis complicated with immunocompromised status

doi:10.3877/cma.j.issn.1674-6880.2026.01.003

Abstract

Abstract:

Objective

To explore prognostic factors of patients with sepsis complicated with immunocompromised status and to construct a predictive model.

Methods

A retrospective analysis was conducted on the clinical data of ICU patients with sepsis in the Affiliated Suzhou Hospital of Nanjing Medical University from April 2023 to February 2025. The general data and laboratory index of patients were analyzed. The statistically significant indicators in the univariate analysis were included in the multivariate logistic regression analysis, and a model of the regression equation was constructed. The model fitting degree was evaluated by the Omnibus test and the Hosmer-Lemeshow test, and the prognosis prediction value of each index was evaluated by drawing receiver operating characteristic (ROC) curves.

Results

In total, 203 sepsis patients were combined with immunocompromised status, including 109 patients (53.7%) in the survival group and 94 patients (46.3%) in the death group. Univariate analysis showed that sequential organ failure assessment (SOFA), lactic acid (Lac), C-reactive protein (CRP), lymphocyte count (LYM), albumin and C-reactive protein/albumin ratio (CAR) were influencing factors of 28-day prognosis in sepsis patients with immune impairment (all P < 0.05). The above indicators were included in the multivariate logistic regression analysis. The research results showed that the SOFA score [odds ratio (OR) = 1.101, 95% confidence interval (CI) (1.004, 1.207), P = 0.041], Lac level [OR = 1.225, 95%CI (1.016, 1.478), P = 0.034] and CAR [OR = 1.183, 95%CI (1.063, 1.317), P = 0.002] were independent risk factors affecting the 28-day prognosis of patients. The logistic regression model was established, and the regression equation was: Logit (P) = 0.096X₁ + 0.203X₂ + 0.168X₃ - 1.854, with X₁, X₂ and X₃ representing the SOFA, Lac and CAR. The Omnibus test and the Hosmer-Lemeshow test suggested that the model was well fitting. The area under the curve of the prediction model was 0.690 [95%CI (0.618, 0.762), P < 0.001], the sensitivity was 60.6%, the specificity was 72.5%, and the Youden index was 0.331.

Conclusions

The SOFA score, Lac and CAR are the influencing factors for the 28-day prognosis of immunocompromised patients with sepsis. The prediction model constructed based on the SOFA score, Lac and CAR can effectively predict the 28-day prognosis of immunocompromised patients with sepsis.

Key words: Sepsis, Immunocompromised, Prognosis

Chen Li, Jun Liu. Prognosis and influencing factors of patients with sepsis complicated with immunocompromised status[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2026, 19(01): 18-24.

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Figures/Tables 4

References 30

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变量	回归系数	标准误	Wald值	OR值	95%CI	P值
年龄（岁）	-0.011	0.012	0.883	0.989	0.966 ~ 1.012	0.347
性别（男/女）	0.322	0.313	1.056	1.380	0.747 ~ 2.548	0.304
高血压	0.091	0.283	0.104	1.095	0.629 ~ 1.908	0.747
糖尿病	0.255	0.313	0.665	1.291	0.699 ~ 2.383	0.415
脑梗死	0.178	0.376	0.224	1.195	0.572 ~ 2.497	0.636
冠状动脉粥样硬化性心脏病	0.511	0.380	1.806	1.666	0.791 ~ 3.509	0.179
感染部位
肺部	0.141	0.328	0.186	1.152	0.605 ~ 2.193	0.667
腹部	-0.129	0.344	0.141	0.879	0.448 ~ 1.725	0.708
泌尿道	0.986	0.829	1.414	2.680	0.528 ~ 13.606	0.234
其他	-0.151	1.010	0.022	0.860	0.119 ~ 6.225	0.881
pH值	-1.817	1.558	1.360	0.163	0.008 ~ 3.446	0.244
BE（mmol/L）	-0.045	0.023	3.750	0.956	0.913 ~ 1.001	0.053
Lac（mmol/L）	0.273	0.098	7.756	1.314	1.084 ~ 1.593	0.005
INR	0.406	0.432	0.885	1.501	0.644 ~ 3.502	0.347
PT（s）	0.043	0.037	1.339	1.044	0.971 ~ 1.123	0.247
FIB（g/L）	0.019	0.086	0.049	1.019	0.861 ~ 1.207	0.824
CRP（mg/L）	0.007	0.002	1.271	1.007	1.003 ~ 1.011	0.001
Hb（g/L）	-0.003	0.006	0.285	0.997	0.985 ~ 1.009	0.594
RBC（× 10¹²/L）	-0.160	0.171	0.870	0.853	0.610 ~ 1.192	0.351
WBC（× 10⁹/L）	-0.026	0.020	1.750	0.974	0.937 ~ 1.013	0.186
PLT（× 10⁹/L）	-0.002	0.001	2.055	0.998	0.996 ~ 1.001	0.152
LYM（× 10⁹/L）	-1.176	0.500	5.521	0.309	0.116 ~ 0.823	0.019
NEUT（× 10⁹/L）	-0.018	0.022	0.646	0.982	0.941 ~ 1.026	0.422
Na⁺（mmol/L）	0.019	0.013	2.310	1.019	0.994 ~ 1.045	0.129
Cl^-（mmol/L）	0.030	0.015	3.780	1.030	1.000 ~ 1.061	0.052
Ca²⁺（mmol/L）	0.383	0.383	0.947	1.452	0.685 ~ 3.077	0.331
白蛋白（g/L）	-0.061	0.025	5.813	0.941	0.896 ~ 0.989	0.016
PLR	< 0.001	< 0.001	1.254	1.000	1.000 ~ 1.001	0.263
NLR	< 0.001	0.003	0.010	1.000	0.995 ~ 1.005	0.919
CAR	0.178	0.054	11.059	1.195	1.076 ~ 1.328	0.001
SOFA评分（分）	0.117	0.044	6.986	1.125	1.031 ~ 1.227	0.008

变量	回归系数	标准误	Wald值	OR值	95%CI	P值
年龄（岁）	-0.011	0.012	0.883	0.989	0.966 ~ 1.012	0.347
性别（男/女）	0.322	0.313	1.056	1.380	0.747 ~ 2.548	0.304
高血压	0.091	0.283	0.104	1.095	0.629 ~ 1.908	0.747
糖尿病	0.255	0.313	0.665	1.291	0.699 ~ 2.383	0.415
脑梗死	0.178	0.376	0.224	1.195	0.572 ~ 2.497	0.636
冠状动脉粥样硬化性心脏病	0.511	0.380	1.806	1.666	0.791 ~ 3.509	0.179
感染部位
肺部	0.141	0.328	0.186	1.152	0.605 ~ 2.193	0.667
腹部	-0.129	0.344	0.141	0.879	0.448 ~ 1.725	0.708
泌尿道	0.986	0.829	1.414	2.680	0.528 ~ 13.606	0.234
其他	-0.151	1.010	0.022	0.860	0.119 ~ 6.225	0.881
pH值	-1.817	1.558	1.360	0.163	0.008 ~ 3.446	0.244
BE（mmol/L）	-0.045	0.023	3.750	0.956	0.913 ~ 1.001	0.053
Lac（mmol/L）	0.273	0.098	7.756	1.314	1.084 ~ 1.593	0.005
INR	0.406	0.432	0.885	1.501	0.644 ~ 3.502	0.347
PT（s）	0.043	0.037	1.339	1.044	0.971 ~ 1.123	0.247
FIB（g/L）	0.019	0.086	0.049	1.019	0.861 ~ 1.207	0.824
CRP（mg/L）	0.007	0.002	1.271	1.007	1.003 ~ 1.011	0.001
Hb（g/L）	-0.003	0.006	0.285	0.997	0.985 ~ 1.009	0.594
RBC（× 10¹²/L）	-0.160	0.171	0.870	0.853	0.610 ~ 1.192	0.351
WBC（× 10⁹/L）	-0.026	0.020	1.750	0.974	0.937 ~ 1.013	0.186
PLT（× 10⁹/L）	-0.002	0.001	2.055	0.998	0.996 ~ 1.001	0.152
LYM（× 10⁹/L）	-1.176	0.500	5.521	0.309	0.116 ~ 0.823	0.019
NEUT（× 10⁹/L）	-0.018	0.022	0.646	0.982	0.941 ~ 1.026	0.422
Na⁺（mmol/L）	0.019	0.013	2.310	1.019	0.994 ~ 1.045	0.129
Cl^-（mmol/L）	0.030	0.015	3.780	1.030	1.000 ~ 1.061	0.052
Ca²⁺（mmol/L）	0.383	0.383	0.947	1.452	0.685 ~ 3.077	0.331
白蛋白（g/L）	-0.061	0.025	5.813	0.941	0.896 ~ 0.989	0.016
PLR	< 0.001	< 0.001	1.254	1.000	1.000 ~ 1.001	0.263
NLR	< 0.001	0.003	0.010	1.000	0.995 ~ 1.005	0.919
CAR	0.178	0.054	11.059	1.195	1.076 ~ 1.328	0.001
SOFA评分（分）	0.117	0.044	6.986	1.125	1.031 ~ 1.227	0.008

变量	回归系数	标准误	Wald值	OR值	95%CI	P值
SOFA评分（分）	0.096	0.047	4.156	1.101	1.004 ~ 1.207	0.041
Lac（mmol/L）	0.203	0.096	4.511	1.225	1.016 ~ 1.478	0.034
CAR	0.168	0.055	9.475	1.183	1.063 ~ 1.317	0.002
常量	-1.854	0.430	18.599	0.157	-	< 0.001

变量	回归系数	标准误	Wald值	OR值	95%CI	P值
SOFA评分（分）	0.096	0.047	4.156	1.101	1.004 ~ 1.207	0.041
Lac（mmol/L）	0.203	0.096	4.511	1.225	1.016 ~ 1.478	0.034
CAR	0.168	0.055	9.475	1.183	1.063 ~ 1.317	0.002
常量	-1.854	0.430	18.599	0.157	-	< 0.001

协变量	AUC	95%CI	最佳截断值	约登指数	P值	敏感度（%）	特异度（%）
SOFA评分（分）	0.598	0.520 ~ 0.676	8.50	0.184	0.016	40.4	78.0
Lac（mmol/L）	0.640	0.564 ~ 0.715	1.45	0.230	0.001	67.0	56.0
CAR	0.642	0.567 ~ 0.718	1.80	0.223	< 0.001	75.5	46.8
预测模型	0.690	0.618 ~ 0.762	0.46	0.331	< 0.001	60.6	72.5

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