Construction and validation of risk prediction model for coagulation dis-order in patients with traumatic brain injury
Objective To investigate the risk factors of coagulation disorder in patients with traumatic brain injury(TBI),establish a risk prediction model,and to provide a theoretical basis for early identification and interventions.Methods Clinical data of 428 TBI patients admitted to the Department of Emergency,Union Shenzhen Hospital of Huazhong University of Science and Technology from January 2020 to December 2023 were retrospectively analyzed.A total of 321 cases of TBI patients from January 2020 to December 2022 were used as the training set,while 107 cases from January to December 2023 were used as the validation set.According to diffuse intravascular coagulation score,the patients were divided into normal group and abnormal group.The influencing factors of coagulation disorder in TBI patients were analyzed,a nomogram model was build,receiver operating characteristic curve were evaluated for the degree of differentiation of the model,the calibration curve was tested for the calibration of the model,and the decision curve analysis was evaluated the benefit of the patient.Results Coagulation disorder occurred in 165 TBI patients(51.4％)in training set.There were statistically significant differences in brain hernia at admission,lung infection,Glasgow coma scale(GCS)score at admission,fluid rehydration volume 24 hours of admission,blood transfusion history 24 hours of admission,operation within 24 hours of admission,injury to use of antibiotics within 24 hours of admission,smoking history,liver disease history,age,activated partial thromboplastin time at admission,prothrombin time at admission,international normalized ratio at admission,fibrinogen at admission,and platelet count at admission between normal group and abnormal group(P＜0.05).GCS score at admission(three to eight points),operation within 24 hours of admission,and injury to use of antibiotics within 24 hours of admission were risk factors for coagulation disorder in TBI patients(OR=3.548,4.650,2.749,P＜0.05).The regression equation was constructed as Logit(P)=1.266 × GCS score at admission(three to eight points)+1.537 × operation within 24 hours of admission+1.011 × injury to use of antibiotics within 24 hours of admission+0.056.The area under the curve for predicting coagulation disorder in TBI patients was 0.828 in the training set and 0.845 in the validation set.The result of Hosmer-Lemeshow test showed that the ideal curve has a high coincidence degree with the calibration curve,and the model has a good calibration ability.When the threshold probabilities of training set and validation set were 0.14-0.86 and 0.13-0.84 respectively,the benefit threshold of the model was wide and had practical value.Conclusion The main risk factors for coagulation disorder in TBI patients are GCS score at admission,operation within 24 hours of admission,and injury to use of antibiotics within 24 hours of admission.The prediction model based on these parameters can better predict the risk of coagulation disorder in TBI patients.
Traumatic brain injuryCoagulation disorderRisk factorsNomogramPrediction model
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万方数据
