Establishment and validation of nomogram prediction model of cefoperazone/sulbactam-induced thrombocytopenia
OBJECTIVE To explore the predictive factors of cefoperazone/sulbactam-induced thrombocytopenia in adult inpatients,and to establish and validate the nomogram prediction model.METHODS Data of adult inpatients treated with cefoperazone/sulbactam in Xi'an Central Hospital from Jun.30th,2021 to Jun.30th,2023 were retrospectively collected.The training set and internal validation set were randomly constructed in a 7∶3 ratio.Singler factor and multifactor Logistic regression analysis were used to screen the independent predictors of cefoperazone/sulbactam-induced thrombocytopenia.The nomogram was drawn by using"RMS"of R 4.0.3 software,and the predictive performance of the model was evaluated by the receiver operating characteristic curve and C-index curve.Hosmer-Lemeshow goodness-of-fit test was used to evaluate the calibration degree of the model.Using the same standard,the clinical data of hospitalized patients receiving cefoperazone/sulbactam in Xi'an First Hospital in the same period were collected for external validation of the nomogram prediction model.RESULTS A total of 1 045 patients in Xi'an Central Hospital were included in this study,among which 67 patients suffered from cefoperazone/sulbactam-induced thrombocytopenia,with an incidence of 6.41%.After the false positive patients were excluded,473 patients were included finally,including 331 in the training set and 142 in the internal validation set.Multifactor Logistic regression analysis showed that age[OR=1.043,95%CI(1.017,1.070)],estimated glomerular filtration rate(eGFR)[OR=0.988,95%CI(0.977,0.998)],baseline platelet(PLT)[OR=0.989,95%CI(0.982,0.996)],nutritional risk[OR=3.863,95%CI(1.884,7.921)]and cumulative defined daily doses(DDDs)[OR=1.082,95%CI(1.020,1.147)]were independent predictors for cefoperazone/sulbactam-induced thrombocytopenia(P＜0.05).The C-index values of the training set and the internal validation set were 0.824[95%CI(0.759,0.890)]and 0.828[95%CI(0.749,0.933)],respectively.The results of the Hosmer-Lemeshow test showed that χ 2 values were 0.441(P=0.802)and 1.804(P=0.406).In the external validation set,the C-index value was 0.808[95%CI(0.672,0.945)],the χ 2 value of the Hosmer-Lemeshow test was 0.899(P=0.638).CONCLUSIONS The independent predictors of cefoperazone/sulbactam-induced thrombocytopenia include age,baseline PLT,eGFR,nutritional risk and cumulative DDDs.The model has good predictive efficacy and extrapolation ability,which can help clinic identify the potential risk of cefoperazone/sulbactam-induced thrombocytopenia quickly and accurately.
cefoperazone/sulbactamthrombocytopeniaadverse drug reactionnomogram prediction modelindependent predictors
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