摘要
目的 建立脑干出血病人短期死亡风险预测的列线图模型,为早期干预和改善预后提供参考依据.方法 将三亚中心医院2017年1月—2022年2月期间诊治的308例脑干出血病人纳入研究,回顾性调查病人基线资料及相关血清指标检测结果,以及随访1年的预后死亡信息.采用单因素、多因素Logistic回归分析差异具有统计学意义的变量,根据筛选的危险因素构建预测脑干出血病人1年内死亡的列线图模型.结果 随访病人病死率为36.36％(112/308),且男性高于女性(x2=36.867,P＜0.05).死亡病人血清D-二聚体、谷草转氨酶、糖化血红蛋白、血钠和白细胞计数等指标,以及平均年龄、心血管病和糖尿病现病史构成比、脑血管病家族史构成比、并发肺部感染和消化道出血构成比均显著高于生存者(t=5.734～33.204,x2=27.434～83.237,P＜0.05).依据性别分层,分别纳入相应危险因素构建列线图模型.模型预测男性和女性脑干出血病人1年内死亡风险的受试者特征曲线下面积分别为 0.759(95％CI=0.683～0.846,P＜0.001)和 0.842(95％CI=0.753～0.928,P＜0.001).结论 通过筛选影响脑干出血病人死亡的风险因素建立了具有良好效能的列线图模型,有助于对病人预后进行准确评估、早期干预、降低病死率.
Abstract
Objective To establish a nomogram model for predicting the risk of short-term mortality in patients with brain-stem hemorrhage,and to provide a basis for performing early intervention and improving prognosis.Methods A retrospective analysis was performed for the data of 308 patients with brainstem hemorrhage who were diagnosed and treated in our hospital from January 2017 to February 2022,including baseline data,serological parameters,and prognosis/death after 1 year of follow-up.Univariate and multivariate Logistic regression analyses were used to investigate statistically significant variables,and the risk fac-tors obtained were used to establish a nomogram model for predicting mortality within one year in patients with brainstem hemor-rhage.Results The mortality rate of the patients was 36.36％(112/308)after follow-up,and the mortality rate in male pa-tients was significantly higher than that in female patients(x2=36.867,P＜0.05).Compared with the patients who survived,the patients who died had significantly higher serum levels of D-dimer,aspartate aminotransferase,glycated hemoglobin,blood so-dium,and white blood cell count,a significantly higher mean age,and significantly higher composition ratios of the patients with the present illness of cardiovascular diseases and diabetes,the patients with a family history of cerebrovascular disease,and the pa-tients with the complications of pulmonary infection and gastrointestinal bleeding(t=5.734-33.204,x2=27.434-83.237,P＜0.05).The patients were stratified by sex,and then corresponding risk factors were included to establish a nomogram model.The model had an area under the ROC curve(AUC)of 0.759(95％CI=0.683-0.846,P＜0.001)in predicting the risk of mortality within 1 year in male patients,while it had an AUC of 0.842(95％CI=0.753-0.928,P＜0.001)in predicting such risk in female patients.Conclusion A nomogram model with good efficacy is successfully established for patients with brainstem hemorrhage based on the risk factors for death obtained by screening,and it can help to accurately assess the prognosis of patients,perform ear-ly intervention,and reduce mortality rate.
基金项目
海南省自然科学基金高层次人才项目(822RC874)
维普
万方数据