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缺血性脑卒中患者住院时间延长预测模型的构建与验证

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目的 构建缺血性脑卒中患者住院时间延长预测模型并进行验证.方法 采用便利抽样法,选取 2021 年 11 月至 2023 年 5 月在常州市某三级甲等综合医院住院的 318 例缺血性脑卒中(cerebral ischemic stroke,CIS)患者作为研究对象,建模组纳入样本量 212 例,验证组样本量为 106 例.建模组 212 例患者根据住院时间长短不同分为住院时间延长组和住院时间正常组,采用二元Logistic回归分析并构建预测模型,将验证组 106 例患者的数据纳入构建的预测模型中,采用受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)和Hosmer-Lemeshow检验模型的预测效能及拟合优度.结果 二元Logistic回归分析结果显示,患有糖尿病、发生住院并发症、Braden评分≤18 分、白细胞计数异常是缺血性脑卒中患者住院时间延长的危险因素.并在此基础上构建了预测模型,预测模型公式为:P=1/[1+exp(-Z)];Z=1.319×是否患有糖尿病(=0 或 1)+1.428×发生住院并发症(=0 或 1)+1.483×Braden评分(=0 或 1)+0.788×白细胞计数(=0 或 1)-3.250.预测模型的Hosmer-Lemeshow检验χ 2=7.430,P=0.191.预测模型的AUC为 0.818(95%CI:0.754~0.883,P<0.001).约登指数为 0.51,最佳截断值为 0.268,敏感度为 78.9%,特异性为 72.3%.数据模型验证结果显示:敏感度为 75.0%,特异性为 74.4%,准确率为 74.5%.结论 患有糖尿病、入院时Braden评分、白细胞计数、发生住院并发症是缺血性脑卒中患者住院时间延长的影响因素.构建的缺血性脑卒中患者住院时间延长预测模型预测价值较好,可为临床决策提供参考.
Development and validation of a prediction model for extended hospitalisation in patient with ischemic stroke
Objective To develop and validate a prediction model for extended hospitalisation in patients with ischemic stroke.Methods A total of 318 patients with ischemic stroke hospitalised between November 2021 and May 2023 in a Grade ⅢA hospital in Changzhou were selected as study objects with a convenience sampling method.The modelling group consisted 212 patients and the validation group included 106 patients.The patients in the modelling group were divided into a group of extended hospital stay and a group of normal hospital stay.Binary logistic regression analysis was conducted to develop the prediction model,and data from the 106 patients in the validation group were then incorporated into the developed prediction model.The prediction performance and goodness-of-fit of the model were accessed using the area under the curve(AUC)of the receiver operation characteristic(ROC)curve and the Hosmer-Lemeshow test.Results Multivariate logistic analysis showed that comorbid diabetes,number of complications during hospitalisation,a Braden score less than 18,and a white blood cell count greater than 3.5×109/L or more than 9.5×109/L were the risk factors of extended hospitalisation in patients with cerebral ischemic stroke.Based on the factors,a prediction model was developed with following formula:P=1/[1+exp(-Z)].Hosmer-Lemeshow test for the prediction model yielded χ 2=7.430,P=0.191.AUC of the prediction model was 0.818(95%CI:0.754-0.883,P<0.001)with Jordon index of 0.51 and the optimal cut-off value of 0.268,sensitivity of 78.9%and specificity of 72.3%The results of the validation of independent data model showed a sensitivity of 75.0%,specificity of 74.4%,and accuracy of 74.5%.Conclusion Comorbid diabetes,Braden score at admission,white blood cell count and the number of complications during hospitalisation are the significant factors that affect the length of hospital stay in the patients with ischemic stroke.The prediction model for extended hospitalisation of the patients with ischemic stroke exhibits good predictive value and can provide reference in clinical decision-making.

ischemic strokelength of hospitalisationprolongprediction model

虞杨、邹圣强、柏慧华、祝晓娟、王聪、曹月

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江苏大学医学院护理系,江苏镇江,212013

常州市第一人民医院,江苏常州,213003

缺血性脑卒中 住院时间 延长 预测模型

2024

现代临床护理
中山大学

现代临床护理

CSTPCD
影响因子:1.317
ISSN:1671-8283
年,卷(期):2024.23(10)