输注红细胞患者非溶血性发热反应预测列线图模型的构建与验证  

The Development and Validation of a Predictive Nomogram Model for Febrile Non-hemolytic Transfusion Reaction in Patients Receiving Red Blood Cells

作　　者：杨梦娇 谭金哲[2] 黎敏 YANG Mengjiao;TAN Jinzhe;LI Min(Shuangliu District First People’s Hospital/Sichuan University West China Airport Hospital,Chengdu 610200,China;Sichuan University West China Hospital,Chengdu 610041,China;Sichuan Tianfu New Area People’s Hospital,Chengdu 610213,China)

机构地区：[1]成都市双流区第一人民医院/四川大学华西空港医院,四川成都610200 [2]四川大学华西医院,四川成都610041 [3]四川天府新区人民医院,四川成都610213

出　　处：《标记免疫分析与临床》2024年第9期1622-1629,共8页Labeled Immunoassays and Clinical Medicine

基　　金：成都市医学科研课题(编号:2022521)。

摘　　要：目的通过回归分析输注红细胞患者的数据,构建非溶血性发热输血反应的列线图预测模型并进行验证,为临床预防非溶血性发热反应提供帮助。方法回顾性分析2021年1月至2023年12月在我院输注悬浮红细胞发生非溶血性发热反应(febrile non-hemolytic transfusion reaction,FNHTR)的61例患者作为观察组,随机选取同时期输注悬浮红细胞未发生FNHTR的189例患者作为对照组,共250例数据纳入建模集。选取同时间段、同级别其他医院输注悬浮红细胞患者91例作为验证集,进行外部验证。利用单因素、多因素Logistic回归法从19个影响因素中筛选出引起FNHTR的独立危险因素,利用Rstudio软件建立FNHTR的预测列线图模型,绘制受试者工作曲线(ROC),并计算ROC曲线下面积(AUC)评估模型的区分能力,绘制校准曲线和临床决策曲线评估模型的校准度与患者净获益情况。结果通过Logistic回归分析,引起患者FNHTR的独立危险因素为:性别、Hb、WBC、ALT、输血反应史以及NLR,OR值以及95%CI分别为:2.567(1.259~5.234)、0.953(0.924~0.983)、0.971(0.916~1.029)、1.022(1.006~1.038)、9.508(2.019~44.773)。将独立危险因素引入R软件成功拟合非溶血性发热反应列线图预测模型,采用Hosmer-Lemeshow拟合优度检验,χ^(2)=5.762,P=0.674,显示该模型具有较好的拟合优度。模型ROC曲线下面积(AUC)为0.803(95%CI 0.744~0.863),显示该模型具有较好的区分能力。采用Bootstrap重复抽样1000次进行模型校准,校准曲线显示模型预测概率与实际概率重合较好,模型具有较好的准确度。通过绘制临床决策曲线,决策曲线显示使用此模型能使患者有较好的净获益。采用外部数据对模型进行外部验证,验证集中AUC为0.784(95%CI 0.662~0.907),校准曲线以及临床决策曲线显示模型在外部数据集中同样具有较好的校准度以及净获益。结论FNHTR的列线图预测模型具有较好的区分能力与准确度,可提示Objective A nomogram prediction model for febrile non-hemolytic transfusion reaction(FNHTR)was constructed and validated through regression analysis of red blood cell transfusion patient data,aiming to provide the assistance in clinical prevention of FNHTR.Methods A retrospective analysis was conducted in 61 cases with FNHTR in our hospital from January,2021 to December,2023.A total of 189 cases without FNHTR during the same period were randomly selected as the control group,resulting in a total of 250 cases included in the modeling process.Additionally,a validation study cohort consisting of 91 patients who received suspended red blood cells from other hospitals during the same period and at the same level was developed for further external validation.The independent risk factors leading to FNHTR were identified among 19 influencing factors using single factor and multiple factor logistic regression models.The predictive nomogram model for FNHTR was established using Rstudio software,and its differentiation ability was evaluated by drawing a receiver operating curve(ROC)and calculating area under ROC curve(AUC).Calibration curves and clinical decision curves were utilized to assess model calibration and patient net benefits.Results According to logistic regression analysis,gender,Hb,WBC,ALT,blood transfusion reaction history,and NLR were identified as independent risk factors for FNHTR with respective OR values and 95%CI.These independent risk factors were then incorporated into R program to successfully fit a non-hemolytic fever reaction nomogram prediction model.Hosmer-Lemeshow goodness-of-fit test indicated that the model had a good fit(χ^(2)=5.762,P=0.674).AUC of the model was 0.803(95%CI 0.744-0.863),demonstrating a strong differentiation ability.Bootstrap sampling process was performed repeatedly for calibration purposes which showed that the predicted probability overlapped well with actual probability indicating a good accuracy.The clinical decision curve demonstrated a good net benefit for patients uti

关 键 词：非溶血性发热性输血反应(FNHTR) 列线图 预测模型 输血安全 

分 类 号：R457.1[医药卫生—治疗学]