老年膝关节骨折患者术后心力衰竭危险因素分析及动态列线图构建  

Analysis of risk factors and construction of a dynamic nomogram for postoperative heart failure in elderly patients with knee joint fractures

作　　者：卿清 薛华薇 陈伟[1] QING Qing;XUE Hua-wei;CHEN Wei(The Fourth Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu,210032,China)

机构地区：[1]南京医科大学第四附属医院,江苏省210032

出　　处：《中国骨与关节杂志》2025年第1期60-64,共5页Chinese Journal of Bone and Joint

摘　　要：目的分析老年膝关节骨折患者术后心力衰竭(heart failure,HF)风险因素并构建一种网络计算器预测术后HF风险。方法选取我院2022年1月至2024年1月手术治疗的512例老年膝关节骨折患者。采用Logistic回归和随机森林(random forest,RF)分析老年膝关节骨折患者术后HF危险因素。将危险因素作为构建列线图预测指标。采用内部数据验证列线图性能,采用接受者操作特征(recipient operating characteristics,ROC)曲线和决策曲线分析评估列线图预测准确性。使用DynNom包将列线图发布至网络中构建老年膝关节骨折术后HF风险的网络计算器。结果512例老年膝关节骨折患者术后HF发病率为18.0%(92/512)。Logistic回归分析结果显示年龄、糖尿病、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级(Ⅲ~Ⅳ级)比例、血红蛋白(hemoglobin,Hb)、脑钠肽(brain natriuretic peptide,BNP)、血小板(platelet,PLT)和手术时间是术后HF独立风险变量。RF算法结果显示术后HF风险相关前6位变量依次为BNP、手术时间、PLT、Hb、丙氨酸转氨酶(alanine transaminase,ALT)和年龄。基于Logistic回归和RF算法的共同风险变量年龄、Hb、BNP、PLT以及手术时间构建预测老年膝关节骨折术后HF的列线图。列线图ROC曲线分析显示曲线下面积(area under the curve,AUC)为0.943,校正曲线分析显示一致性指数为0.905,表明该列线图预测准确性高。结论基于年龄、Hb、BNP、PLT以及手术时间构建的预测老年膝关节骨折术后HF风险网络计算器,能为临床医师积极进行心脏风险评估提供实用性工具。Objective To analyse risk factors for postoperative heart failure(HF)in elderly knee fracture patients and construct a network calculator to predict postoperative HF risk.Methods Elderly knee fracture patients who were surgically treated between January 2022 and January 2024 in our hospital were selected.Logistic regression and random forest(RF)were used to analyse the risk factors for postoperative HF in elderly knee fracture patients.Risk factors were used as predictors for constructing nomogram.Internal data were used to validate the performance of the nomogram,and receiver operating characteristic(ROC)curves and decision curve analyses were used to assess the predictive accuracy of the nomogram.The DynNom package was used to publish the nomogram to the web to construct a web-based calculator of postoperative HF risk in older adults with knee fractures.Results The incidence of postoperative HF in 512 elderly patients with knee fractures was 18.0%(92/512).Logistic regression analysis showed that age,diabetes mellitus,proportion of American Society of Anesthesiologists(ASA)classification(gradeⅢ-Ⅳ),haemoglobin(Hb),brain natriuretic peptide(BNP),platelets(PLT)and operation time were independent risk variables for postoperative HF.RF algorithm results showed that the top 6 variables associated with the risk of postoperative HF were,in order,BNP,duration of surgery,PLT,Hb,alanine aminotransferase(ALT)and age.A nomogram predicting postoperative HF in elderly knee fractures was constructed based on the common risk variables age,Hb,BNP,PLT,and operative time from logistic regression and RF algorithm.The ROC curve analysis of the nomogram showed an area under the curve(AUC)of 0.943,and the calibration curve analysis showed a consistency index of 0.905,indicating the predictive accuracy of the nomogram.Conclusions A network calculator for predicting postoperative HF risk after knee fracture in the elderly,constructed on the basis of age,Hb,BNP,PLT,and operative time,can provide a practical tool for clinicians to acti

关 键 词：老年人 骨折 膝关节 心力衰竭 列线图 

分 类 号：R683.4[医药卫生—骨科学]