ICU老年非手术病人静脉血栓栓塞症风险预测模型的构建及验证  

Construction and validation of the prediction model for venous thromboembolism risk in elderly non-surgical patients in ICU

作　　者：杨行 马莎莎[2] 许红梅[1] 陈晓琳[2] 刘莉[2] 商全梅[2] YANG Xing;MA Shasha;XU Hongmei;CHEN Xiaolin;LIU Li;SHANG Quanmei(Binzhou Medical College,Shandong 256600 China;不详)

机构地区：[1]滨州医学院,山东256600 [2]滨州医学院附属医院

出　　处：《护理研究》2023年第5期791-799,共9页Chinese Nursing Research

基　　金：滨州医学院护理学院研究生科研创新支持计划,编号:HYCX2021-001。

摘　　要：目的:调查重症监护室(ICU)老年非手术病人发生静脉血栓栓塞症(VTE)的危险因素,构建列线图预测模型并进行验证。方法:回顾性收集2017年1月—2022年1月滨州市某三级甲等综合医院ICU的524例老年非手术病人的临床资料,根据是否发生VTE将病人分为VTE组和非VTE组,采用Logistic回归分析病人发生VTE的危险因素,并构建和验证列线图预测模型。结果:524例病人中,发生VTE166例,发生率为31.7%。多因素Logistic回归分析结果显示,制动时间、脑卒中、VTE病史、下肢静脉曲张史、使用血管活性药物、D-二聚体、纤维蛋白原是ICU老年非手术病人发生VTE的影响因素。利用上述7个预测因素构建列线图模型,经Bootstrap重复抽样1000次对列线图模型进行内部验证,绘制校准曲线图显示校正曲线与理想曲线拟合良好,Hosmer-Lemeshow拟合优度检验结果显示,χ^(2)=8.460,P=0.390。C-index为0.869,受试者工作特征曲线下面积为0.871,灵敏度为0.729,特异度为0.891,准确率为81.49%,提示模型的区分度以及准确率较好。临床决策分析曲线(DCA)显示模型有较好的临床有效性。结论:基于ICU老年非手术病人发生VTE的危险因素构建列线图模型并经过验证,此模型有较好的预测效能以及临床有效性,便于医护人员早期、准确地预测VTE的发生并采取针对性的干预措施。Objective:To explore the risk factors of venous thromboembolism(VTE)in elderly non-surgical patients in ICU,and to construct and verify the nomogram prediction model.Methods:The clinical data of 524 patients in the ICU of a tertiary grade A hospital in Binzhou from January 2017 to January 2022 were collected retrospectively.According to whether VTE occurred,the patients were divided into VTE group and non-VTE group.The risk factors of VTE were analyzed by logistic regression,and the Nomogram prediction model was constructed.Results:Among 524 patients,166 occurred VTE,with an incidence of 31.7%.Multivariate Logistic regression analysis showed that braking time,stroke,VTE history,varicose veins of the lower extremities,vasoactive drugs,D-Dimer and fibrinogen were the predictors of VTE in elderly non-surgical patients with ICU.The Nomogram model was constructed by using the above seven prediction factors.After bootstrap repeated sampling 1000 times,the Nomogram model was internally verified,and the calibration curve was drawn,which showed that the calibration curve fitted well with the ideal curve.The Hosmer-Lemeshow goodness of fit test showed thatχ^(2)=8.460,P=0.390.The calculated C-index was 0.869,the AUC was 0.871,the sensitivity was 0.729,the specificity was 0.891,and the accuracy was 81.49%,suggesting that the discrimination of the model was good.The decision curve analysis(DCA)showed that the model had good clinical effectiveness.Conclusions:We construct a Nomogram model based on the risk factors of VTE in elderly non-surgical patients in ICU,and it is verified that this model has good prediction efficiency and clinical effectiveness,so that medical staff can predict the occurrence of VTE early and accurately and take targeted intervention measures.

关 键 词：静脉血栓栓塞症 重症监护室 危险因素 预测模型 列线图 调查研究 

分 类 号：R472[医药卫生—护理学]