老年股骨粗隆间骨折患者术后贫血预测模型的构建与验证  

Development and Validation of postoperative anemia prediction model in elderly patients with intertrochanteric fracture

作　　者：王贝贝 崔振义 王静[1] 王晗妍 吕红芝[3] 李秀婷[4] Wang Beibei;Cui Zhenyi;Wang Jing;Wang Hanyan;Li Xiuting(Department of Pharmacy Intravenous Admixture Services,The Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Department of Second Operating room,The Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Orthopaedic Institution of Hebei Province,The Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Trauma Emergency Center Ward Four,The Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院静脉用药调配中心,石家庄050051 [2]河北医科大学第三医院第二手术室,石家庄050051 [3]河北医科大学第三医院、河北省骨科研究所,石家庄050051 [4]河北医科大学第三医院创伤急救中心四病区,石家庄050051

出　　处：《中华老年骨科与康复电子杂志》2024年第6期355-362,共8页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：国家自然科学青年基金项目(82102584);河北省2024年度省卫生健康委医学科学研究课题计划项目(20242118);河北省卫生健康委2024年政府资助临床医学优秀人才培养项目(ZF2024075)。

摘　　要：目的分析老年股骨粗隆间骨折患者术后贫血的影响因素并构建预测模型,探究该模型的预测价值。方法采用回顾性研究,收集2020年1月至2021年12月在河北医科大学第三医院骨科就诊的451例老年股骨粗隆间骨折患者临床资料及化验指标与检查结果,按7∶3比例随机分配到建模集(319例)、验证集(132例)。对建模集资料进行单因素和多因素logistic回归分析筛选出老年股骨粗隆间骨折患者术后贫血的影响因素,并构建列线图预测模型。模型的表现和临床实用性分别用受试者工作特征(ROC)曲线、校准曲线、决策曲线进行评估,同时引入验证集数据对模型进行内部验证。结果建模集319例老年粗隆间骨折患者中出现贫血为105例(32.90%)。单因素结果显示性别(OR=0.555,95%CI:0.318,0.970)、住院天数(OR=1.104,95%CI:1.040,1.173)、美国麻醉医师协会(ASA)分级评分(OR=0.649,95%CI:0.478,0.883)、入院血红蛋白(Hb)(OR=1.021,95%CI:1.005,1.036)、入院B型钠尿肽(BNP)(OR=0.996,95%CI:0.993,0.999)、左心射血指数(LVEF)(OR=1.067,95%CI:1.021,1.116)有统计学差异(P<0.05)。多因素logistic回归分析表明性别(OR=0.498,95%CI:0.272,0.912)、住院天数(OR=1.137,95%CI:1.063,1.216)、入院Hb(OR=1.024,95%CI:1.007,1.041)、入院BNP(OR=0.997,95%CI:0.993,0.999)、LVEF(OR=1.050,95%CI:1.001,1.102)是老年股骨粗隆间患者术后贫血的影响因素(P<0.05),基于上述因素构建老年粗隆间骨折患者贫血列线图模型,模型预测老年股骨粗隆间骨折患者术后贫血的ROC曲线下面积为0.717(95%CI:0.657,0.776)、训练集模型截断值0.341,灵敏度0.634,特异度0.711,约登指数0.345。当决策曲线中建模集与验证集的阈概率分别为0%~70%与0%~62%时,净获益高于不采取及全部采取干预的极端曲线,表明预测模型具有临床有效性。结论基于性别、住院天数、入院Hb、入院BNP、LVEF建立的预测模型对老年股骨粗隆间骨折患者贫血风险具有�Objective To analyze the influencing factors of postoperative anemia in elderly patient with intertrochanteric fracture and establish a predictive model to explore the predictive value of this model.Methods A retrospective study was conducted to collect the clinical data,laboratory indicators and examination results of 451 elderly patients with intertrochanteric fractures who were treated in the orthopedics department of a hospital from January 2020 to December 2021,and were randomly assigned to the modeling set(319 cases)and validation set(132 cases)according to a ratio of 7:3.Univariate and multivariate logistic regression analysis was performed to screen out the influencing factors of postoperative anemia in elderly patients with intertrochanteric fracture,and a nomogram prediction model was constructed.The performance and clinical practicability of the model were evaluated by Receiver Operating Characteristic(ROC)curve,calibration curve and decision curve respectively,and validation set data were introduced for internal validation of the model.Results Among 319 elderly patients with intertrochanteric fracture in the modelingset,105(32.90%)had anemia.Univariate results showed gender(OR=0.555,95%CI:0.318-0.970),length of hospital stay(OR=1.104,95%CI:1.040,1.173),American Society of Anesthesiologists(ASA)grade(OR=0.649,95%CI:0.478,0.883),Hemoglobin(Hb)at admission(OR=1.021,95%CI:1.005-1.036),B-type natriuretic peptide(BNP)at admission(OR=0.996,95%CI:0.993,0.999),left ventricular ejection fraction(LVEF)(OR=1.067,95%CI:1.021,1.116)there was a statistical difference(P<0.05).Multivariate logistic regression analysis showed that gender(OR=0.498,95%CI:0.272,0.912),length of stay(OR=1.137,95%CI:1.063,1.216),Hb at Admission(OR=1.024,95%CI:1.007,1.041),BNP at Admission(OR=0.997,95%CI:0.993,0.999),LVEF(OR=1.050,95%CI:1.001,1.102)were the influential factors for postoperative anemia in elderly intertrochanteric patients(P<0.05).Based on these factors,anemia column diagram model in elderly patients with intertrochanteric fr

关 键 词：老年人 股骨粗隆间骨折 贫血 影响因素 预测模型 

分 类 号：R687.3[医药卫生—骨科学]