重症急性胰腺炎患者住院时间延长预测模型的构建与验证  

Construction and validation of a prediction model for prolonged hospitalization in patients with severe acute pancreatitis

作　　者：刘倩倩[1] 马柳一 韩冬冬 高敏 田源 周小燕 Liu Qianqian;Ma Liuyi;Han Dongdong;Gao Min;Tian Yuan;Zhou Xiaoyan(Department of Emergency,Hebei Province Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Cangzhou 061000,Hebei,China)

机构地区：[1]河北省沧州中西医结合医院急诊科,河北沧州061000

出　　处：《中华危重病急救医学》2024年第11期1174-1178,共5页Chinese Critical Care Medicine

基　　金：河北省中医药管理局科研计划项目(2021310)。

摘　　要：目的探讨重症急性胰腺炎(SAP)患者住院时间延长的危险因素,并构建风险预测模型。方法回顾性选择2015年1月至2023年12月河北省沧州中西医结合医院急诊科住院的SAP患者作为研究对象,以住院时间的75%作为分界点,将患者分为住院时间正常组和延长组。收集患者临床指标,采用多因素Logistic回归分析SAP患者住院时间延长的独立危险因素,以此建立预测模型并绘制列线图;通过受试者工作特征曲线(ROC曲线)评价预测模型的效能;运用Hosmer-Lemeshow拟合优度检验评估模型的准确性;运用决策曲线分析(DCA)评估模型的临床实用性;采用Bootstrap法对模型进行内部验证。结果共纳入510例SAP患者,住院时间为18(6,44)d,其中住院时间正常组(<24 d)400例,住院时间延长组(≥24 d)110例。多因素Logistic回归分析显示,腹腔积液〔优势比(OR)=4.163,95%可信区间(95%CI)为2.105~8.234〕、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ;OR=1.320,95%CI为1.185~1.470)、C-反应蛋白(CRP;OR=1.006,95%CI为1.002~1.011)、改良CT严重指数(MCTSI;OR=1.461,95%CI为1.213~1.758)、降钙素原(PCT;OR=1.303,95%CI为1.095~1.550)、白蛋白(OR=0.510,95%CI为0.419~0.622)为SAP患者住院时间延长的独立危险因素(均P<0.01)。以上述独立危险因素构建预测模型,ROC曲线分析显示,模型的曲线下面积(AUC)为0.922(95%CI为0.896~0.947),最佳截断值为0.726时,敏感度为87.3%,特异度为85.3%;Hosmer-Lemeshow检验显示,χ^(2)=5.79,P=0.671,说明该模型具有良好的预测效能和拟合度。DCA曲线显示,模型在阈概率为0.1~0.7时能给患者带来更多的临床获益。Bootstrap内部验证显示,模型具有较高的一致性(AUC=0.916)。结论合并腹腔积液、高APACHEⅡ评分、高CRP、高MCTSI、高PCT及低白蛋白水平与SAP患者住院时间延长显著相关;据此建立的预测模型可协助临床医师对SAP患者做出更科学的临床决策。Objective To construction the risk factors associated with prolonged hospitalization in patients with severe acute pancreatitis(SAP)and develop a prediction model for assessing these risks.Methods SAP patients admitted to the department of emergency of Hebei Province Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2015 to December 2023 were retrospectively selected as the study subjects.The 75%of hospital stay was used as the cut-off point,and the patients were categorized into a normal group and an extended group.Clinical indicators of patients were collected,and independent risk factors for prolonged hospital stay in SAP patients were analyzed using multifactor Logistic regression.A prediction model was established,and a nomogram was created.The efficiency of the prediction model was evaluated using a receiver operator characteristic curve(ROC curve).The accuracy of the model was assessed using Hosmer-Lemeshow goodness-of-fit test.Decision curve analysis(DCA)was employed to evaluate the clinical applicability of the model.Finally,internal validation of the model was conducted using Bootstrap method.Results A total of 510 patients with SAP were included,and the length of hospital stay was 18(6,44)days,including 400 cases in the normal group(<24 days)and 110 cases in the extended group(≥24 days).Multivariate Logistic regression analysis showed that abdominal effusion[odds ratio(OR)=4.163,95%confidence interval(95%CI)was 2.105-8.234],acute physiology and chronic health evaluationⅡ(APACHEⅡ;OR=1.320,95%CI was 1.185-1.470),C-reactive protein(CRP;OR=1.006,95%CI was 1.002-1.011),modified CT severity index(MCTSI;OR=1.461,95%CI was 1.213-1.758),procalcitonin(PCT;OR=1.303,95%CI was 1.095-1.550)and albumin(OR=0.510,95%CI was 0.419-0.622)were independent risk factors for prolonged hospital stay in SAP patients(all P<0.01).ROC curve analysis showed that the area under the curve(AUC)of the model was 0.922(95%CI was 0.896-0.947),the optimal cut-off value was 0.726,the sensitivity was

关 键 词：重症急性胰腺炎 住院时间 预测模型 内部验证 

分 类 号：R576[医药卫生—消化系统]