基于Cox比例风险模型探讨早发败血症新生儿早期死亡的影响因素

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[中图分类号]R174

[文献标识码]A [文章编号]1673—5293（2025）07—0097—06

Exploring the risk factors for early death in neonates with early-onset sepsis based on the Cox proportional hazards model

HUANG Xiangrong，YANG Zuming，CAI Yan，GAO Chuchu，FENG Zongtai （ ， ，2l5OO2，）

[AbstractObjectiveToinvestigatetheriskfactorsassociatedwitharlymortalityinneonateswithearlyonsetsepsis（EO），ith theaimproviding evidenceforfuturequalityimprovement initiatives.Methods Thisretrospectivecohortstudyincluded eonates diagnosedwithEOSandhospitalizedatAfiliated etweeJanuary2land December 2O2o. neonates were divided into two groups：the death group （survival time <7 days after birth）and the survival group （survival time ⩾7 days）.Clinical data were collected retrospectively for both groups.After 1：1 propensity score matching basedongestationalageandyearadmision，aCoxproportionalhazardsmodelwasconstructedtoidentifyfactorsassociatedwith earlymortality.ResultsAtotal16OneonateswithEOSwereincludedcomprsing34clinicalldagnosedcasesand126cired cases.Among the pathogens identified through blood culture，Streptococcus agalactiae was the most common （22.22% .Of the total cases，l33 survived and 27 died，resulting in a case fatality rate 16.88% .Compared to the survival group，neonates in the death group had significantly lower gestational ages and birth weights （ t=-7.86 and -7.11 ，respectively，both P<0.001） .After propensity scorematching，univariateCoxregressionanalysisrevealed severalfactorsassociatedwithearly mortalityinEOS neonates：premature rupture membranes >18 hours HR=0.21，95%CI：0.05–0.88） ，birth asphyxia （ HR=2.45，95%CI：1.08– 5.54），admission temperature <36.5∘C （ HR=2.85，95%CI：1.18–6.88） ，need for mechanical ventilation upon admission （ HR= （204 2.50，95%CI ：1.03-6.06），use vasopressors upon admission （HR=3.72，95%CI：1.65-8.38 ），and positive blood culture（ HR=

0.25，95%CI：0.11-0.59），all withP < 0.05.Multivariate Coxanalysis identified vasopressoruse at admission （ 11R=2.53，95%CI ： 1.07-5.99） and positive blood culture （ HR=0.33，95%CI：0.13–0.83 ）asindependent factors significantly associated with early mortality （ P<0.05 ）.Conclusion requirement for vasopressor support upon admisson is an independent risk factor for early mortality in neonates with EOS，while a positive blood culture appears to be a protective factor.

[Key words]neonate;early-onset sepsis;Cox proportional hazards model; prognosis

由于机体免疫功能发育尚不成熟，败血症在新生儿临床实践中十分常见，也是导致新生儿死亡的主要原因之一[1]。（剩余7727字）