Nomogram predictive model for in-hospital mortality risk in elderly ICU patients with urosepsis.

BACKGROUND: Urinary tract infection (UTI) is a common cause of sepsis. Elderly patients with urosepsis in intensive care unit (ICU) have more severe conditions and higher mortality rates owing to factors such as advanced age, immunosenescence, and persistent host inflammatory responses. However, comprehensive studies on nomograms to predict the in-hospital mortality risk in elderly patients with urosepsis are lacking. This study aimed to construct a nomogram predictive model to accurately assess the prognosis of elderly patients with urosepsis and provide therapeutic recommendations. METHODS: Data of elderly patients with urosepsis were extracted from the Medical Information Mart for Intensive Care (MIMIC) IV 2.2 database. Patients were randomly divided into training and validation cohorts. A predictive nomogram model was constructed from the training set using logistic regression analysis, followed by internal validation and sensitivity analysis. RESULTS: This study included 1,251 patients. LASSO regression analysis revealed that the Glasgow Coma Scale (GCS) score, red cell distribution width (RDW), white blood count (WBC), and invasive ventilation were independent risk factors identified from a total of 43 variables studied. We then created and verified a nomogram. The area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA) of the nomogram were superior to those of the traditional SAPS-II, APACHE-II, and SOFA scoring systems. The Hosmer-Lemeshow test results and calibration curves suggested good nomogram calibration. The IDI and NRI values showed that our nomogram scoring tool performed better than the other scoring systems. The DCA curves showed good clinical applicability of the nomogram. CONCLUSIONS: The nomogram constructed in this study is a convenient tool for accurately predicting in-hospital mortality in elderly patients with urosepsis in ICU. Improving the treatment strategies for factors related to the model could improve the in-hospital survival rates of these patients.

Advances in the Deformation and Failure of Concrete Pavement under Coupling Action of Moisture, Temperature, and Wheel Load.

The deformation and cracking of concrete will lead to various deterioration processes, which will greatly reduce the durability and service life of the concrete pavement. The relating previous studies and analysis revealed that the coupling action of environmental temperature, moisture, and wheel load will cause cracking and seriously affect the normal service and durability of pavement concrete. This paper presents theoretical and numerical state-of-the-art information in the field of deformation and failure of pavement concrete under coupling action of moisture, temperature, and wheel load and draws some conclusions. (a) Concrete is a typical porous material, moisture and heat transfer theory has obtained enough data to simulate the hygro-thermo properties of concrete, and the relationship between moisture and heat is very clear. (b) There are few studies on concrete pavement or airport pavement considering the coupling action of moisture, temperature, and wheel load. (c) Concrete pavement is subjected to hygro-thermal-mechanical coupling action in service, which has the characteristics of a similar period and its possible fatigue effect. (d) COMSOL software has certain advantages for solving the coupled hygro-thermal-mechanical of concrete.