终末期肾病新入血液透析患者再住院影响因素及其风险预测模型  

Influencing Factors and Risk Prediction Model of Re-hospitalization in Patients with End-stage Renal DiseaseNewly Admitted to Undergo Hemodialysis

作　　者：张健美 李亚光[1] 李慧妍[1] ZHANG Jianmei;LI Yaguang;LI Huiyan(Hemodialysis Unit,the First Hospital of Qinhuangdao City,Qinhuangdao,Hebei 066000,China)

机构地区：[1]秦皇岛市第一医院血液透析室,河北秦皇岛066000

出　　处：《临床误诊误治》2024年第4期35-41,共7页Clinical Misdiagnosis & Mistherapy

基　　金：秦皇岛市科学技术研究与发展计划(202004A101)。

摘　　要：目的探讨终末期肾病(ESRD)新入血液透析患者再住院的影响因素,据此构建风险预测模型。方法选取2015年1月—2020年5月ESRD新入血液透析194例,根据透析1年内有无再住院分为住院组(113例)与非住院组(81例)。收集2组临床资料,采用多因素Logistic和Lasso回归分析ESRD新入血液透析患者再住院的影响因素,利用列线图构建其风险预测模型,校正曲线和受试者工作特征(ROC)曲线对风险预测模型进行评估。结果住院组与非住院组年龄、体质量指数(BMI)、糖尿病肾病、血管通路、血尿素、血肌酐、血尿素下降率、肾小球滤过率(eGFR)、血红蛋白(Hb)、白蛋白(Alb)、B型脑钠肽(BNP)、C反应蛋白(CRP)、血清铁蛋白、尿素清除指数(KT/V)比较,差异有统计学意义(P<0.05,P<0.01)。将上述指标纳入Lasso回归分析,得出10个因素:年龄、BMI、糖尿病肾病、血管通路、eGFR、Hb、Alb、BNP、CRP、KT/V。年龄、糖尿病肾病、血管通路为导管、BNP、CRP是ESRD新入血液透析患者再住院的独立危险因素,BMI、eGFR、Hb、Alb、KT/V是其独立保护因素(P<0.05,P<0.01)。基于以上因素构建患者再住院的风险预测模型,校正曲线、ROC曲线评估该模型具有较高一致性和预测价值。结论ESRD新入血液透析患者再住院影响因素包括年龄、BMI、糖尿病肾病、血管通路、eGFR、Hb、Alb、BNP、CRP、KT/V,利用上述因素构建患者再住院风险预测模型,该模型具有较高预测价值。Objective To investigate the influencing factors of re-hospitalization in patients with end-stage renal disease(ESRD)newly admitted to undergo hemodialysis,so as to establish a risk prediction model.Methods A total of 194 patients with ESRD newly admitted to undergo hemodialysis from January 2015 to May 2020 were selected and divided into inpatient group(n=113)and non-inpatient group(n=81)according to whether they were re-hospitalized within 1 year of hemodialysis.Clinical data of the two groups were collected.Multivariate Logistic and Lasso regression were used to analyze the influencing factors of re-hospitalization in patients with ESRD newly admitted to undergo hemodialysis.The risk prediction model was constructed by using the nomogram.The correction curve and receiver operating characteristic(ROC)curve were used to evaluate the risk prediction model.Results There were significant difference in age,body mass index(BMI),diabetic nephropathy,vascular pathways,blood urea nitrogen(BUN),blood creatinine,decline rate of BUN,estimated glomerular filtration rate(eGFR),hemoglobin(Hb),albumin(Alb),brain type B natriuretic peptide(BNP),C reactive protein(CRP),serum ferritin,urea clearance index(KT/V)between inpatient group and non-inpatient group(P<0.05,P<0.01).The above indicators were included in Lasso regression analysis,and 10 factors were obtained:age,BMI,diabetic nephropathy,vascular access,eGFR,Hb,Alb,BNP,CRP,and KT/V.Age,diabetic nephropathy,catheter access,BNP and CRP were independent risk factors for re-hospitalization in patients with ESRD newly admitted to undergo hemodialysis,while BMI,eGFR,Hb,Alb and KT/V were independent protective factors(P<0.05,P<0.01).Based on the above factors,a risk prediction model for patient re-hospitalization was constructed.Correction curve and ROC curve assessed that the model had high consistency and predictive value.Conclusion The influencing factors of re-hospitalization of patients with ESRD newly admitted to undergo hemodialysis include age,BMI,diabetic nephropathy,vascul

关 键 词：终末期肾病 血液透析 再住院 影响因素 列线图 肾小球滤过率 糖尿病肾病 C反应蛋白 

分 类 号：R692.5[医药卫生—泌尿科学]