Construction and validation of a cardiovascular event risk model for dia-betic nephropathy-maintenance haemodialysis patients by lung ultrasound B-line score and novel inflammatory markers
Objective To construct and validate a cardiovascular events risk model in diabetic nephropathy-maintenance haemodialysis(DN-MHD)patients by lung ultrasound B-line score(LUBS)and novel inflammatory markers(monocyte to high-density lipoprotein cholesterol ra-tio[MHR],systemic immune-inflammation index[SII],and C-reactive protein to albumin ratio[CAR]).Methods A total of 122 DN-MHD patients admitted to Beijing Puren Hospital from October 2018 to October 2022 were selected,and they were divided into training set(86 cases)and valida-tion set(36 cases)according to the ratio of 7:3.Patients with cardiovascular events were included in occurrence group,the influencing factors of cardiovascular events in patients with DN-MHD were analyzed,so as to construct a nomogram prediction model and verified;the predictive efficacy of the nomogram prediction model for the occurrence of cardiovascular events in DN-MHD patients was assessed by receiver operating characteris-tic curve;and predictive models for clinical benefit were analyzed by decision curves analysis.Results Cardiovascular events occurred in 33 pa-tients in the training set and 13 patients in the validation set.There was no significant difference in general data between the training set and the validation set(P＞0.05).There were significant differences in dialysis age,hypotension during dialysis,LUBS,MHR,SII,and CAR between two groups(P＜0.05).LUBS(OR=5.693),MHR(OR=3.241),SII(OR=4.877),and CAR(OR=4.052)were the influencing factors of cardiovascular events in DN-MHD patients(P＜0.05).The nomogram prediction model was well distinguished;the calibration curve fits well with the ideal curve.The sensitivity of the nomogram prediction model in the training set to predict the occurrence of cardiovascular events in DN-MHD patients was 88.60％,the specificity was 90.20％,and the area under the curve was 0.883;the sensitivity of the nomogram prediction model in the validation set to predict the occurrence of cardiovascular events in DN-MHD patients was 87.50％,the specificity was 89.10％and the area under the curve was 0.874.The maximum clinical benefit can be obtained when the threshold probability of the nomogram prediction model was 0.00-0.23.Conclusion The nomogram prediction model based on LUBS,MHR,SII,and CAR can better evaluate the risk of cardiovascular events in DN-MHD patients.
Diabetic nephropathyMaintenance hemodialysisLung ultrasound B-line scoreNovel inflammatory markersCardiovascular eventsRisk model
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