重症胰腺炎CRRT治疗患者发生非计划性下机预测模型的建构  

Construction of a Predictive Model for Unplanned Withdrawal in Severe Pancreatitis Patients Undergoing CRRT Treatment

作　　者：李林莉 杨家慧[1] LI Linli;YANG Jiahui(Blood Purification Center of Jiangsu Provincial People's Hospital,Nanjing,Jiangsu 210029,China)

机构地区：[1]江苏省人民医院血液净化中心,江苏南京210029

出　　处：《转化医学杂志》2025年第3期16-21,共6页Translational Medicine Journal

基　　金：2022年度省老年健康科研项目(LKM2022040)。

摘　　要：目的探讨重症胰腺炎连续肾脏替代治疗(CRRT)患者非计划性下机的影响因素,并对患者非计划性下机发生风险构建列线图预测模型,为干预措施的制定提供依据。方法回顾性收集2021年1月至2024年1月于江苏省人民医院接受CRRT治疗的85例重症胰腺炎患者临床资料,并根据非计划性下机发生情况将患者分为非计划性下机组(32例)和计划性下机组(53例),采用单因素及多因素Logistic回归模型,分析重症胰腺炎患者CRRT治疗非计划性下机的影响因素,并构建列线图风险预测模型,绘制受试者工作特征(ROC)曲线验证其预测效能。结果非计划性下机组患者使用肝素抗凝比例、发生血管通路功能障碍比例、有机械通气比例、血细胞比容均高于计划性下机组,血流速度、凝血酶原活动度低于计划性下机组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,使用肝素抗凝、发生血管通路功能障碍,有机械通气、血细胞比容高是重症胰腺炎患者CRRT治疗非计划性下机发生的独立危险因素(OR>1,P<0.05),血流速度高、凝血酶原活动度高是重症胰腺炎患者CRRT治疗非计划性下机发生的保护因素(OR<1,P<0.05)。构建列线图风险预测模型,验证模型显示C-index值为0.968,具有良好区分度;绘制标准曲线显示,校准曲线和Y-X直线相近,模型准确度良好;对风险模型预测效能进行验证,结果显示,列线图风险预测模型评估重症胰腺炎患者CRRT治疗非计划性下机的AUC为0.968,95%CI:0.937~0.999,P<0.05,敏感度为0.969,特异度为0.906,约登指数为0.875,具有良好的预测效能。结论使用肝素抗凝、发生血管通路功能障碍,有机械通气、血流速度、凝血酶原活动度、血细胞比容均是重症胰腺炎患者CRRT治疗非计划性下机发生的影响因素,且基于上述因素构建的列线图风险模型可预测患者CRRT治疗非计划性下机发生风险。Objective To explore the influencing factors of unplanned withdrawal in patients with severe pancreatitis undergoing continuous renal replacement therapy(CRRT),and to construct a nomogram prediction model for the risk of unplanned withdrawal in patients,providing a basis for the development of intervention measures.Method A retrospective collection of clinical data was conducted on 85 patients with severe pancreatitis who received CRRT treatment at Jiangsu Provincial People's Hospital from January 2021 to January 2024.Patients were divided into unplanned and planned groups based on the occurrence of unplanned episodes(n=32 and n=53,respectively).Univariate and multivariate Logistic regression models were used to analyze the influencing factors of unplanned termination of CRRT in patients with severe pancreatitis,and a nomogram risk prediction model was constructed.The receiver operating characteristic(ROC)curve was drawn to verify its predictive efficacy.Results The proportion of patients using heparin anticoagulation,experiencing vascular access dysfunction,having mechanical ventilation,and having a higher hematocrit was all higher in unplanned group patients than in planned group patients.Blood flow velocity and prothrombin activity were lower in unplanned group patients than in planned group patients,with statistical significant differences(P<0.05).The results of multiple Logistic regression analysis showed that the use of heparin anticoagulation,vascular access dysfunction,mechanical ventilation,and high hematocrit were independent risk factors for unplanned abortion in patients with severe pancreatitis undergoing CRRT treatment(OR>1,P<0.05).High blood flow velocity and prothrombin activity were protective factors for unplanned abortion in patients with severe pancreatitis undergoing CRRT treatment(OR<1,P<0.05).The nomogram risk prediction model was constructed,and the verification model showed that the C-index value was 0.968,with good discrimination.The standard curve showed that the calibration curve was s

关 键 词：重症胰腺炎 连续肾脏替代治疗 非计划性下机 影响因素 列线图模型 风险预测 

分 类 号：R576[医药卫生—消化系统]