主动脉夹层患者术后死亡影响因素的Cox回归分析及列线图预测模型的构建
Cox regression analysis of postoperative prognostic factors and construction of nomogram prediction model for patients with aortic dissection
肖子亚 1王新艳 1师猛 1李腾 1孟凡亮 1吕廷廷1
作者信息
- 1. 济宁医学院附属医院急诊科,济宁 272029
- 折叠
摘要
目的 探讨主动脉夹层(aortic dissection,AD)患者行手术或介入治疗后死亡风险相关影响因素,构建多因素Cox回归分析列线图预测模型.方法 回顾性分析济宁医学院附属医院2019年1月至2021年12月收治AD患者的临床资料,对其生存时间进行随访,采用Kaplan-Meier法绘制生存曲线,不同Stanford分型的AD患者生存率差异的比较采用Log-Rank检验,应用Cox回归模型进行单因素和多因素生存分析筛选预后相关影响因素,根据多因素分析的结果建立AD术后死亡风险列线图模型,应用C指数评价对模型的区分度,绘制校准曲线评价模型的准确度,采用临床决策曲线评价模型的临床获益情况.结果 共纳入256例AD患者,行手术或介入治疗后死亡37例(4.45％),术后3、6、12个月总体生存率分别为90.23％、87.50％及85.55％.不同Stanford分型的AD患者术后生存率比较差异无统计学意义(x2=2.30,P=0.130).多因素Cox回归分析结果表明高血压史(HR=3.791,95％CI:1.150～12.501,P=0.029)、累及分支血管数量(HR=1.210,95％CI:1.029～1.422,P=0.021)、术前左心室射血分数(HR=0.936,95％CI:0.880～0.996,P=0.038)和围术期并发症(HR=4.024,95％CI:1.839～8.807,P＜0.001)是AD患者的独立预后因素.进一步构建了AD患者术后3、6、12个月生存率的预测模型列线图,C指数为0.778,校准曲线图提示模型的准确度较好,临床决策曲线显示模型的临床获益较好.结论 高血压史、累及分支血管数量、术前左心室射血分数和围术期并发症是AD患者术后死亡的独立危险因素,基于上述因素构建的列线图预测模型能够用于评估AD患者术后生存情况.
Abstract
J Objective To explore the related prognostic factors in patients with aortic dissection(AD)after surgery or interventional therapy,and to construct a multi-factor Cox regression analysis nomogram prediction model.Methods The clinical data of patients diagnosed with AD in the emergency department of Affiliated Hospital of Jining Medical University of Shandong Province from January 2019 to December 2021 were collected to analyze retrospectively.The survival time was followed up,the survival curve was drawn by Kaplan-Meier method,the difference of survival rate among different Stanford types was tested by Log-Rank test,and Cox regression univariate and multivariate survival analysis was used to screen the prognostic factors.According to the results of multivariate analysis,the death risk nomogram model after AD was established,the differentiation of the model was evaluated by C-index,the accuracy of the model was evaluated by calibration curve,and the clinical benefit of the model was evaluated by decision curve analysis(DCA).Results A total of 256 patients with AD were included,the mortality rate was 4.45％(37/256),and the overall survival rates at 3 months,6 months and 12 months after operation were 90.23％,87.50％and 85.55％,respectively.There was no significant difference in postoperative survival rate among AD patients with different Stanford types(x2=2.30,P=0.13).Cox multivariate regression analysis showed that history of hypertension(HR=3.791,95％CI 1.150-12.501,P=0.029),number of branch vessels involved(HR=1.210,95％CI 1.029-1.422,P=0.021),preoperative left ventricular ejection fraction(LVEF)(HR=0.936,95％CI 0.880-0.996,P=0.038)and perioperative complications(HR=4.024,95％CI 1.839-8.807,P＜0.001)were independent prognostic factors in patients with AD.Furthermore,the predictive nomogram model of 3-month,6-month and 12-month survival rate in patients with AD was constructed,and the C-index was 0.778.The calibration curve indicated that the accuracy of the model was good,and the clinical benefit of the DCA model was good.Conclusions Hypertension history,the number of branch vessels involved,preoperative LVEF and perioperative complications are independent risk factors of postoperative death in patients with AD.The nomogram prediction model based on the above factors can be used to evaluate the postoperative survival of patients with AD.
关键词
主动脉夹层/Cox回归/列线图Key words
Aortic dissection/Cox regression analysis/Nomogram引用本文复制引用
基金项目
山东省医药卫生科技发展计划资助项目(202010000964)
济宁市重点研发计划资助项目(2022YXNS045)
济宁医学院附属医院"苗圃"科研计划资助项目(MP-MS-2020-006)
出版年
2024
NETL
NSTL
万方数据