Construction and evaluation of nomogram prediction model for lower extremity deep vein thrombosis in elderly patients with emergency hip fracture before operation
Objective To explore the risk factors of lower extremity deep vein thrombosis(DVT)in elderly patients with emergency hip fracture before operation,and to build a nomogram prediction model.Methods A total of 495 elderly patients with emergency hip fracture admitted to Beijing Jishuitan Hospital Affiliated to Capital Medical University from May 2017 to January 2020 were selected as the research subjects.The patients were divided into the DVT group and non-DVT group according to whether lower extremity DVT occurred or not before operation.The patient's gender,age,body mass index(BMI),course of disease,fracture type,hypertension history,hyperglycemia hist ory,smoking history,drinking history,past surgical history,pulmonary/urinary tract infection,bed rest time,systolic blood pressure,and diastolic blood pressure were collected through the hospital's medical record system.Before operation,5 mL of peripheral elbow venous blood was collected and centrifuged for 15 min at 3 000 r·min-1 to obtain the serum.The fasting blood glucose(FBG),total cholesterol(TC),red blood cell(RBC)count,white blood cell(WBC)count,triglyceride(TG),sodium ions,potassium ions,calcium ions,platelets,fibrinogen(FIB),and D-dimer levels were measured using the monitor.The indices of patients in the DVT and non-DVT groups were compared.Logistic regression was used to analyze the independent influencing factors of lower extremity DVT in elderly patients with emergency hip fracture before operation,and receiver operating characteristic(ROC)curve was used to analyze the predictive effect of each independent influencing factor for lower extremity DVT in elderly patients with emergency hip fracture before operation.The independent influencing factors were incorporated into the nomogram prediction model,and the C-index,ROC curve,and calibration curve in R software were used to evaluate the predictive effect of the nomogram prediction model for the preoperative risk of lower extremity DVT in elderly patients with emergency hip fracture.Results Among 495 elderly patients with emergency hip fracture,52 patients(10.51％)had lower extremity DVT before operation.There was no significant difference in gender,BMI,course of disease,fracture type,hypertension,smoking history,drinking history,pulmonary/urinary tract infection,systolic blood pressure,diastolic blood pressure,FBG,TC,RBC,WBC,TG,sodium ions,potassium ions,calcium ions,and platelet between the DVT group and non-DVT group(P＞0.05).The age,proportion of hyperglycemia,proportion of past surgical history,bed rest time,and levels of FIB and D-dimer in the DVT group were significantly higher than those in the non-DVT group(P＜0.05).Logistic regression analysis showed that older age,hyperglycemia,surgical treatment,long bed rest time,and high FIB and D-dimer levels were independent risk factors for lower extremity DVT in elderly patients with emergency hip fracture before operation(P＜0.05).The ROC curve showed that age,hyperglycemia,operation or not,bed rest time,FIB and D-dimer levels had certain predictive values for lower extremity DVT in elderly patients with emergency hip fracture before operation(P＜0.05).Based on age,hyperglycemia,operation or not,bed rest time,FIB and D-dimer levels,the nomogram prediction model was established,and the calibration curve C-index value was 0.953.The AUC values of the modeling group and validation group were 0.953 and 0.940,respectively.Conclusion Older age,hyperglycemia,surgical treatment,long bed rest time,high FIB and D-dimer levels are independent risk factors for lower extremity DVT in elderly patients with emergency hip fracture before operation.Based on age,hyperglycemia,operation or not,bed rest time,FIB and D-dimer levels,the nomo-gram model for predicting lower extremity DVT in elderly patients with emergency hip fracture before operation has good discrimination and predictive effect,which can directly predict the probability of lower extremity DVT in elderly patients with emergency hip fracture before operation.
elderly hip fracturelower extremity deep vein thrombosisrisk factorsnomograph prediction model
维普
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