Construction and validation of Alignment Diagram model for risk of parenteral nutrition-associated cholestasis in extremely/ultra-low birth weight infants
Construction and validation of Alignment Diagram model for risk of parenteral nutrition-associated cholestasis in extremely/ultra-low birth weight infants
陈淑燕 1许景林 1蔡雅丽 1胡云婷 1朱庆龄 1刘志勇 1王赫 1郑敬阳 1陈冬梅 1李巍
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作者信息
1. 福建医科大学研究生院,福州 350000;2福建省泉州市儿童医院新生儿科 362000
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摘要
目的 探讨极/超低出生体重儿发生肠外营养相关性胆汁淤积症（PNAC）的高危因素并建立风险列线图预测模型。 方法 回顾性分析2019年1月至2020年12月泉州市儿童医院新生儿科收治住院的极/超低出生体重儿的临床资料，采用多因素Logistic回归分析筛选PNAC发生的独立危险因素；利用R软件构建PNAC的列线图预测模型，并通过ROC曲线评价模型的性能。 结果 共纳入203例极/超低出生体重儿，中位出生胎龄29.14（28.00，30.86）周，中位出生体重1 170（1 000，1 300）g，其中26例（12.81%）发生PNAC。多因素Logistic回归分析显示，肠外营养持续时间（OR=1.015，95%CI 1.003~1.034）、葡萄糖累积用量（OR=1.014，95%CI 1.001~1.028）、小于胎龄儿（OR=3.455，95%CI 1.127~10.589）、新生儿败血症（OR=3.142，95%CI 1.039~9.503）是影响PNAC发生的独立危险因素（P＜0.05）；将以上独立危险因素引入R软件构建列线图模型，ROC曲线下面积为0.835（95%CI 0.731~0.842），Hosmer-Lemeshow拟合优度检验结果显示：χ 2=5.34，自由度=8，P=0.72，绘制校准曲线提示模型的预测概率与实际发生率的一致性良好，具有较好的准确度。 结论 基于静脉营养持续时间、葡萄糖累积用量、小于胎龄儿、新生儿败血症4个独立危险因素构建的列线图模型呈现出较高的预测能力，有望为预防或降低极/超低出生体重儿发生PNAC提供一个直观、简便的可视化工具。 Objective To explore the high-risk factors for parenteral nutrition associated cholestasis（PNAC）in extremely/ultra-low birth weight infants，and establish a risk Alignment Diagram prediction model. Methods We retrospectivly analyzed the clinical data of hospitalized extremely/ultra-low birth weight infants admitted to Neonatology Department at Quanzhou Children's Hospital from January 2019 to December 2020，using multivariate Logistic regression analysis to screen for independent risk factors for the occurrence of PNAC.An Alignment Diagram model prediction model for PNAC was constructed by using R software，and the performance of the model was evaluated through receiver operating characteristic curves. Results A total of 203 extremely/ultra-low birth weight infants were included，with a median gestational age of 29.14（28.00，30.86）weeks and a median birth weight of 1 170（1 000,1 300）g.Among them，26（12.81%）cases developed PNAC.Multivariate Logistic regression analysis showed that the duration of parenteral nutrition（OR=1.015，95%CI 1.003-1.034），the cumulative amount of glucose（OR=1.014，95%CI 1.001-1.028），small for gestational age（OR=3.455，95%CI 1.127-10.589），and neonatal sepsis（OR=3.142，95%CI 1.039-9.503）were independent risk factors for PNAC（P＜0.05）；The four independent risk factors mentioned above were introduced into R software to construct an Alignment Diagram model，the area under the receiver operating characteristic curve was 0.835（95% CI 0.842-0.731），and the results of the Hosmer Limeshow goodness of fit test show that：χ2=5.34，degree of freedom=8，P=0.72.A calibration curve indicated good consistency between the predicted probability of the model and the actual occurrence rate，with good accuracy. Conclusion The Alignment Diagram model constructed based on four independent risk factors of the duration of parenteral nutrition，glucose accumulation，small for gestational age infants，and neonatal sepsis exhibits high predictive ability，and is expected to provide an intuitive and convenient visualization tool for preventing or reducing the occurrence of PNAC in extremely/ultra-low birth weight infants
Abstract
Objective To explore the high-risk factors for parenteral nutrition associated cholestasis（PNAC）in extremely/ultra-low birth weight infants，and establish a risk Alignment Diagram prediction model. Methods We retrospectivly analyzed the clinical data of hospitalized extremely/ultra-low birth weight infants admitted to Neonatology Department at Quanzhou Children's Hospital from January 2019 to December 2020，using multivariate Logistic regression analysis to screen for independent risk factors for the occurrence of PNAC.An Alignment Diagram model prediction model for PNAC was constructed by using R software，and the performance of the model was evaluated through receiver operating characteristic curves. Results A total of 203 extremely/ultra-low birth weight infants were included，with a median gestational age of 29.14（28.00，30.86）weeks and a median birth weight of 1 170（1 000,1 300）g.Among them，26（12.81%）cases developed PNAC.Multivariate Logistic regression analysis showed that the duration of parenteral nutrition（OR=1.015，95%CI 1.003-1.034），the cumulative amount of glucose（OR=1.014，95%CI 1.001-1.028），small for gestational age（OR=3.455，95%CI 1.127-10.589），and neonatal sepsis（OR=3.142，95%CI 1.039-9.503）were independent risk factors for PNAC（P＜0.05）；The four independent risk factors mentioned above were introduced into R software to construct an Alignment Diagram model，the area under the receiver operating characteristic curve was 0.835（95% CI 0.842-0.731），and the results of the Hosmer Limeshow goodness of fit test show that：χ2=5.34，degree of freedom=8，P=0.72.A calibration curve indicated good consistency between the predicted probability of the model and the actual occurrence rate，with good accuracy. Conclusion The Alignment Diagram model constructed based on four independent risk factors of the duration of parenteral nutrition，glucose accumulation，small for gestational age infants，and neonatal sepsis exhibits high predictive ability，and is expected to provide an intuitive and convenient visualization tool for preventing or reducing the occurrence of PNAC in extremely/ultra-low birth weight infants
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