Analysis Of Risk Factors For Adverse Prognosis Of Wasp Sting Patients And Establishment Of Quantitative Prediction Model

Objective: To study the early evaluation value of the poisoning severity score(PSS)on the severity of wasp sting patients in Suining.The risk factors of death of wasp sting patients were analyzed,and establish a clinical prognostic model of death.The risk factors of AKI were analyzed,and establish a clinical prognostic model of AKI.Methods: From January 2016 to December 2018,363 patients with wasp sting in Suining Central Hospital were taken as the research objects.The demographic characteristics,clinical and laboratory examination data of these patients were retrospectively analyzed.On admission,the severity of the wasp sting patients was assessed according to the PSS and the criterion in the Chinese expert consensus on standardized diagnosis and treatment of wasp sting(CECC),and the correlation of them was analyzed.According to the state of discharge,the patients were divided into survival group and death group for cohort analysis.Univariate and multivariate logistics regression were used to analyze the risk factors of death of wasp sting patients.The clinical prognostic model of death was constructed according to the risk factors,and 1000 times repeated sampling were done to include the data to verify the model internally.According to the presence of AKI,the patients were divided into AKI group and non-AKI group for cohort analysis.The risk factors of AKI were analyzed with logistics regression model.The clinical prognostic model of AKI was constructed according to the risk factors,and 1000 times repeated sampling were done to include the data to verify the model internally.Results: Three hundred sixty-three wasp sting patients were included in this study,219 were male and 144 were female,with an average age of 55.9 ± 16.3 years.Fifty-one patients(14%)developed gross hematuria,27(7.4%)developed oliguria or anuria,and 39(10.7%)developed acute kidney injury(AKI).One hundred and five patients(28.9%)developed rhabdomyolysis,61(16.8%)developed hemolysis,56(18.5%)developed multiple organ failure(MODS),13(3.6%)developed acute respiratory distress syndrome(ARDS).Seven people(1.9%)were admitted to ICU,45(12.4%)received blood purification,and 14 patients(3.9%)died.There was a correlation between PSS and CECC in assessing the severity of wasp sting patients(r=0.435,P<0.001).There was no significant difference in AUC between PSS and CECC in predicting the death of wasp sting patients(Z=0.7230,P=0.4697).The PSS of patients in the death group was significantly higher than that in the survival group(2vs.1,P<0.001).Gender(female),age,the number of stings,and PSS were independent risk factors for the death of wasp stings.Based on the 4 independent risk factors screened by the above regression analysis,a nomogram model was constructed to predict the death risk of wasp sting patients,and the risk prediction ability of the model was verified.The predicted value C-index was 0.962,indicating that the clinical prognostic model had a good prediction accuracy and discrimination.The internally verified AUC was 0.962(95%C.I.0.936-0.988,P<0.001),indicating that the nomogram had a high predictive value.PSS and lactate dehydrogenase(LDH)on admission were independent risk factors for AKI.Based on the 2independent risk factors screened by the above regression analysis,a nomogram model was constructed to predict the risk of AKI of wasp sting patients,and the risk prediction ability of the model was verified.The predicted value C-index was 0.981,indicating that the clinical prognostic model had a good prediction accuracy and discrimination.The internally verified AUC was 0.981(95%C.I.0.965-0.996,P<0.001),indicating that the nomogram had a high predictive value.Conclusion: The PSS can be used as CECC to evaluate the severity of wasp sting patients at an early stage and guide the decision-making of medical staff in Suining.Female,age,the number of stings,and PSS were independent risk factors for the death of wasp stings.The clinical prognostic model established in this study can accurately predict the occurrence risk of death.PSS and LDH on admission were independent risk factors for the AKI of wasp stings.The clinical prognostic model established in this study can accurately predict the occurrence risk of AKI.