空腔脏器穿孔患者院内死亡的危险因素分析和预测模型构建  

Risk factors analysis and prediction model construction of hospital death in patients with hollow viscera perforation

作　　者：李志强 江贵军 叶璐[1] 朱开梅[3] 吕菁君[1] LI Zhiqiang;JIANG Guijun;YE Lu;ZHU Kaimei;LYU Jingjun(Department of Emergency,Renmin Hospital of Wuhan University,Wuhan,430060,China;Department of Critical Care Medicine,Renmin Hospital of Wuhan University;Department of Gastrointestinal Surgery,Renmin Hospital of Wuhan University)

机构地区：[1]武汉大学人民医院急诊科,武汉430060 [2]武汉大学人民医院重症医学科 [3]武汉大学人民医院胃肠外科

出　　处：《临床急诊杂志》2022年第12期822-827,共6页Journal of Clinical Emergency

摘　　要：目的:分析导致空腔脏器穿孔患者死亡的危险因素并建立预测模型,为临床医生提供便捷有效的预测方法。方法:回顾性收集2019年1月—2022年6月我院急诊科收治的空腔脏器穿孔患者为研究对象。包括患者的一般临床资料,入院第1天的生命体征、既往病史及实验室检查结果、是否进行外科手术、住院天数(总住院天数与ICU住院天数)、病情转归等,对上述指标进行统计学分析并构建列线图。结果:本研究最终纳入182例患者,根据最终是否死亡分为死亡组及存活组。将2组患者基线资料进行单因素以及logistic多因素回归分析后,得出年龄≥80岁、冠心病、休克、恶性肿瘤、NT-ProBNP是空腔脏器穿孔患者短期不良预后的5个独立危险因素。基于上述独立影响因素构建列线图,通过绘制ROC曲线并计算曲线下面积(AUC值)来评估其区分度,通过R语言程序包绘制校准曲线并计算均方根误差(RMSE)来评估模型准确度,结果显示,该模型具有较好的区分度(AUC=0.959)和均方根误差(RMSE=0.029),利用约登指数计算其灵敏度及特异度,该模型的灵敏度为91.3%,特异度为88.7%;决策曲线分析也显示出该列线图具有较高的临床获益性。结论:本文通过单因素及多因素分析后得出的空腔脏器穿孔患者的短期不良预后的独立危险因素包括年龄≥80岁、冠心病、休克、恶性肿瘤、NT-ProBNP。将这5个指标联合,建立预测性能较好的评估患者死亡风险的列线图,为临床医生提供简单有效的预测方法。Objective: To analyze the risk factors leading to the death of patients with hollow viscera perforation and to establish a prediction model to provide clinicians with a convenient and effective prediction method and accurate treatment timing to reduce the mortality of patients. Methods: Patients with hollow viscera perforation admitted to our hospital from from January 2019 to June 2022 were retrospectively collected as research subjects. The general clinical data of the patients were collected, including vital signs on the first day of admission, previous medical history and laboratory test results, whether to perform surgery, days of hospitalization(total hospitalization days and ICU days), and prognosis. Statistical analysis of the above indicators is conducted and a nomogram is constructed. Results: This study finally included 182 patients, who were divided into death group and survival group according to whether they died or not. Univariate and logistic multivariate regression analysis was performed on the baseline data of the two groups, and it was concluded that age ≥80, coronary heart disease, shock, malignant tumor, and NT-ProBNP were five independent risk factors for poor short-term prognosis of patients with hollow viscera perforation. A nomogram was constructed based on the above independent influencing factors, and the discrimination was evaluated by drawing the ROC curve and calculating the AUC value. The R language package was used to draw the calibration curve and calculate the root mean square error(RMSE) to evaluate the model accuracy. The results showed that the model had good discrimination(AUC=0.959) and root mean square error(RMSE=0.029). The Youden index was used to calculate its sensitivity and specificity. The sensitivity of the model was 91.3% and the specificity was 88.7%. Decision curve analysis also showed that the nomogram had a high clinical benefit. Conclusion: The independent risk factors for poor short-term prognosis of patients with hollow viscera perforation obtained by univa

关 键 词：空腔脏器穿孔 死亡 危险因素 列线图 预测模型 

分 类 号：R656.1[医药卫生—急诊医学]