骨科创伤急诊患者预后的影响因素分析及列线图模型的构建与验证  

Analysis of Factors Influencing Prognosis of Emergency Orthopedic Trauma Patients and Construction and Validation of a Nomogram Model

作　　者：陈立娟[1] 耿欣[1] 姚立军 魏立友[1] 李春江[1] 吴春云[1] 张艳[1] CHEN Li-juan;GENG Xin;YAO Li-jun;WEI Li-you;LI Chun-jiang;WU Chun-yun;ZHANG Yan(Emergency Department,the Second Hospital of Tangshan,Tangshan 063015,China)

机构地区：[1]唐山市第二医院急诊科,河北唐山063015

出　　处：《南昌大学学报（医学版）》2024年第1期60-64,共5页Journal of Nanchang University：Medical Sciences

基　　金：河北省卫健委医学科研课题计划(20201446)。

摘　　要：目的分析骨科创伤急诊患者预后的影响因素,构建预后风险预测的列线图模型并对其进行验证。方法选取2020年1月至2022年3月在唐山市第二医院就诊的骨科创伤急诊患者312例。根据患者就诊后28 d是否存活分为存活组(n=260)和死亡组(n=52)。单因素分析2组一般资料、损伤严重程度评分(ISS)及血清学指标[纤维蛋白原(FIB)、D-二聚体(D-D)、血管生成素2(Ang2)、可溶性白细胞分化抗原14(sCD14)]水平;Logistic多因素回归分析筛选骨科创伤急诊患者预后的独立危险因素;基于获得的独立危险因素构建风险列线图模型,并验证模型的预测效能。结果2组创伤程度、创伤部位数量、失血性休克、现场急救情况、ISS评分及FIB、D-D、Ang2、sCD14水平比较,差异均有统计学意义(P<0.05)。创伤部位数量≥2(OR=5.802)、失血性休克(OR=16.355)、ISS评分≥18.42分(OR=13.782)、Ang2≥2911.15 pg·mL^(-1)(OR=6.821)、sCD14≥4.77 pg·mL^(-1)(OR=9.347)均是骨科创伤急诊患者预后的独立危险因素(P<0.05);由这5个因素构建的列线图模型预测预后的敏感度、特异度分别为90.38%、79.15%,C-index为0.978。结论创伤部位数量、失血性休克、ISS评分、Ang2、sCD14是骨科创伤急诊患者预后的影响因素,根据这些因素构建的列线图可较好地预测患者的预后。Objective To analyze the factors affecting the prognosis of emergency patients with orthopedic trauma,and to construct and validate a nomogram model for predicting the risk of prognosis.Methods A total of 312 emergency orthopedic trauma patients admitted to Tangshan Second Hospital from January 2020 to March 2022 were selected.According to whether the patients were alive 28 days after admission,they were divided into survival group(n=260)and death group(n=52).Univariate analysis was conducted to compare the general data,injury severity score(ISS),and serum levels of fibrinogen(FIB),D-dimer(D-D),angiopoietin 2(Ang2)and soluble CD14(sCD14)between the two groups.Logistic multivariable regression analysis was used to screen the independent risk factors for the prognosis of emergency orthopedic trauma patients.Based on the obtained independent risk factors,a risk nomogram model was constructed and the predictive performance of the model was validated.Results There were significant differences in the degree of trauma,number of trauma sites,hemorrhagic shock,on-site first aid,ISS,and levels of FIB,D-D,Ang2 and sCD14 between the two groups(P<0.05).The number of trauma sites≥2(OR=5.802),hemorrhagic shock(OR=16.355),ISS≥18.42(OR=13.782),Ang2≥2911.15 pg·mL^(-1)(OR=6.821),and sCD14≥4.77 pg·mL^(-1)(OR=9.347)were independent risk factors for the prognosis of emergency patients with orthopedic trauma(P<0.05).The sensitivity and specificity of the nomogram model constructed from these five factors for predicting prognosis were 90.38%and 79.15%,respectively,with a C-index of 0.978.Conclusion The number of trauma sites,hemorrhagic shock,ISS,Ang2 and sCD14 are factors affecting the prognosis of emergency patients with orthopedic trauma,and the nomogram constructed according to these factors can be used to better predict the prognosis.

关 键 词：骨科创伤 急诊 列线图模型 预后 影响因素 

分 类 号：R641[医药卫生—外科学] R459.7[医药卫生—临床医学]