基于列线图构建成人破伤风患者死亡风险预测模型  

A mortality risk prediction model for adult tetanus patients based on nomogram

作　　者：胡建洋 张磊 刘筱 花嵘 燕宪亮 刘林 HU Jianyang;ZHANG Lei;LIU Xiao;HUA Rong;YAN Xianliang;LIU Lin(Emergency Medicine Department of Xuzhou Medical University Affiliated Hospital,221002,China)

机构地区：[1]徐州医科大学附属医院急诊医学科,221002

出　　处：《传染病信息》2025年第2期167-173,共7页Infectious Disease Information

基　　金：江苏省基础研究计划(自然科学基金)面上项目(BK20231162)。

摘　　要：目的回顾性分析成人破伤风患者的临床特征、实验室检查及治疗方法对预后的影响,建立预测成人破伤风患者死亡风险的列线图模型,并评估其准确性和临床效能。方法收集2011年3月至2023年10月徐州医科大学附属医院收治的90例成人破伤风患者的临床资料,将患者分位死亡组(30例)和存活组(60例),比较2组患者的人口学资料、实验室检查、临床表现和治疗方法。采用单因素和多因素回归分析筛选出预测成人破伤风患者死亡风险的独立危险因素。利用R语言软件进行逻辑回归模型的可视化处理,得到列线图模型,并评估该模型的准确性和临床效能。结果90例破伤风患者平均年龄为(61.23±14.20)岁。多因素Logistic回归分析结果显示,年龄、Ablett分级、住院时间和机械通气在模型中均具有统计学意义(P<0.05),且均被确认为患者死亡的危险因素(OR>1)。构建出的列线图模型预测成人破伤风死亡风险的一致性指数为0.855。通过Bootstrap法进行内部验证,校准曲线显示模型预测成人破伤风患者死亡风险与实际发生风险的平均绝对误差为0.029,受试者工作特征曲线下面积为0.855,诊断阈值为0.339,对应灵敏度为80.0%、特异度为83.3%。决策曲线分析显示模型的表现和预测效果良好。结论年龄、Ablett分级、住院时间和机械通气是影响成人破伤风患者发生死亡的独立危险因素,基于上述4个危险因素建立的预测模型可准确预测成人破伤风患者的死亡风险。Objective To analyze the relationship between clinical characteristics,laboratory fingdings and treatment methods and prognosis of adult tetanus patients,a nomogram model was established to predict the mortality risk in adult tetanus patients,and its accuracy and clinical efficacy were evaluated.Methods Clinical data of 90 adult patients with tetanus from the Affliated Hospital of Xuzhou Medical University from March 2011 to October 2023 were collected,including 30 cases in the death group and 60 cases in the survival group.The demographic data,laboratory tests,clinical manifestations and treatment methods were compared between the two groups.Univariate and multivariate regression analyses were performed to identify independent risk factors for predicting the risk of death in adult tetanus patients.R language software was used to visualize the logistic regression model,obtain the nomogram model,and evaluate the accuracy and clinical efficacy of the model.Results The mean age of 90 tetanus patients was(61.23+14.20)years.Multivariate Logistic regression analysis showed that age,Ablett grade,length of stay and mechanical ventilation were independent risk factors for mortality(P<0.05,OR>1).The concordant index for predicting the risk of death from tetanus in adults was 0.855 in the nomogram model based on the above independent risk factors.Bootstrap method was used to internally verify the nomogram model.The calibration curve showed that the average absolute error between the model's prediction of the risk of death and the actual risk of occurrence in adult tetanus patients was 0.029,the area under R0C curve was 0.855,with a diagnostic threshold was 0.339,and the corresponding sensitivity was 80 The specificity was 83.3%.Decision curve analysis shows that the performance and prediction effect of the model are good.ConclusionsAge,Ablett grade,length of stay and mechanical ventilation are independent risk factors for mortality in adult tetanus patients.The nomogram model based on these risk factors can accurately predi

关 键 词：破伤风 列线图 预后 预测模型 

分 类 号：R633.1[医药卫生—外科学]