基于列线图构建儿童连续性肾脏替代治疗体外循环衰竭预测模型  

Development of a nomogram-based risk prediction model for extracorporeal circulation failure children on continuous renal replacement therapy

作　　者：全梓林 尹燕 崔冬梅 赵立艳 王方圆 王娟[1] 何文静 胡宇航 陈诚 梁绮祯 宋利 QUAN Zi-lin;YIN Yan;CUI Dong-mei;ZHAO Li-yan;WANG Fang-yuan;WANG Juan;HE Wen-jing;HU Yu-hang;CHEN Cheng;LIANG Qi-zhen;SONG LI(The Department of Nephrology,the Guangdong Provincial People’s Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China)

机构地区：[1]南方医科大学附属广东省人民医院(广东省医学科学院)肾内科血液净化中心,广州510080

出　　处：《中国血液净化》2025年第1期13-17,共5页Chinese Journal of Blood Purification

基　　金：广东省医学科学技术研究基金项目(A2020635);广东省医学科学技术研究基金项目(B2023011);广东省医学科学技术研究基金项目(A2024441);广州市科技计划项目(202102080292)。

摘　　要：目的本研究旨在探讨儿童连续性肾脏替代治疗(continuous renal replacement thera-py,CRRT)过程中发生体外循环衰竭的影响因素,并构建预测模型。方法回顾性分析2014─2021年在广东省人民医院接受CRRT的370例儿童患者数据,根据CRRT 24小时内是否发生体外循环衰竭分为衰竭组和非衰竭组。通过Lasso回归和临床判断筛选出与体外循环衰竭相关的主要变量,并采用多因素Lo-gistic回归构建预测模型。结果最终基于体质量(OR=0.932,95%CI:0.910~0.954,P<0.001)、平均超滤速度(OR=1.012,95%CI:1.007~1.017,P<0.001)、血流量不足(OR=26.535,95%CI:12.507~56.297,P<0.001)和乳酸(OR=1.095,95%CI:1.014~1.183,P=0.021)构建的预测模型,受试者工作特征曲线下面积为0.891。校准曲线和临床决策曲线显示模型具有良好的预测能力和临床获益。结论体质量低、平均超滤速度快、血流量不足和乳酸高是儿童CRRT 24小时体外循环衰竭的独立危险因素,此构建的预测模型具有较好的预测效能。Objective This study aimed to investigate the factors influencing extracorporeal circulation failure during continuous renal replacement therapy(CRRT)in pediatric patients and to develop and validate a predictive model.Methods A retrospective analysis was conducted on data from 370 pediatric patients who received CRRT at Guangdong Provincial People's Hospital between 2014 and 2021.Patients were divided in-to failure and non-failure groups based on the occurrence of extracorporeal circulation failure within 24 hours of CRRT initiation.Through the application of the Lasso regression regularization method and clinical judge-ment,the key variables associated with extracorporeal circulatory failure were identified and selected.These variables were then incorporated into a multivariate logistic regression analysis to identify independent risk factors,leading to the construction of a predictive model.Results The final predictive model was based on body weight(OR=0.932,95%CI:0.910~0.954,P<0.001),mean ultrafiltration rate(OR=1.012,95%CI:1.007~1.017,P<0.001),insufficient blood flow(OR=26.535,95%CI:12.507~56.297,P<0.001),and lac-tate levels(OR=1.095,95%CI:1.014~1.183,P=0.021).The area under the receiver operating characteristic(ROC)curve for the model was 0.891(85.61%~92.48%).Calibration curves and clinical decision curves in-dicated that the model has good predictive capability and clinical utility.Conclusion Low body weight,high mean ultrafiltration rate,insufficient blood flow,and elevated lactate levels are independent risk factors for ex-tracorporeal circulation failure within 24 hours of CRRT in pediatric patients.The predictive model based on these factors demonstrates high predictive accuracy.

关 键 词：儿童 连续性肾脏替代治疗 体外循环衰竭 预测模型 

分 类 号：R459.5[医药卫生—治疗学]