首页|基于LASSO回归的冠心病患者发生心力衰竭的风险预测模型构建

基于LASSO回归的冠心病患者发生心力衰竭的风险预测模型构建

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目的 分析冠心病患者发生心力衰竭的危险因素,构建并验证冠心病(coronary heart disease,CHD)患者发生心力衰竭的列线图预测模型.方法 回顾性分析2022年1月至12月于沈阳医学院附属第二医院住院治疗的453例CHD患者的临床资料,其中CHD合并心力衰竭患者278例,未合并心力衰竭患者175例,将患者按7:3分为训练组(318例)和验证组(135例),应用R软件进行LASSO回归筛选危险因素,Logistic回归建立预测模型并构建列线图,采用校准曲线和受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评价模型的校准度和区分度.结果 LASSO回归分析最终从22个变量中筛选出5个危险因素,Logistic回归结果显示年龄、吸烟、有心肌梗死病史、纽约心脏病协会(New York Heart Association,NYHA)心功能分级Ⅳ级、左室射血分数(left ventricular ejection fraction,LVEF)均是CHD患者发生心力衰竭的独立危险因素(P<0.05).模型公式:Z=2.927+0.045×年龄+0.886×吸烟+0.808×心肌梗死病史-2.829×NYHA心功能分级Ⅳ级+0.037×LVFF.对该模型进行内部验证,曲线下面积为0.727(95%CI:0.588~0.752),敏感度为40.4%,特异性为84.3%,约登指数为0.247.校准曲线预测值与实际值一致性较高,Brier评分0.106.结论 基于LASSO回归构建的CHD患者发生心力衰竭的风险预测模型具有较好的区分度和预测效能,可作为医务人员对患者进行风险预测的评估工具.
Construction of risk prediction model of heart failure in patients with coronary heart disease based on LASSO regression
Objective To analyze the risk factors of heart failure in patients with coronary heart disease(CHD),and to construct and verify a nomogram prediction model for the risk of heart failure in patients with CHD.Methods The clinical data of 453 patients with CHD who were hospitalized in the Second Affiliated Hospital of Shenyang Medical College from January to December 2022 were retrospectively analyzed,including 278 patients with CHD combined with heart failure and 175 patients without heart failure.The patients were divided into training group(318 cases)and validation group(135 cases)according to the ratio of 7:3.R software was applied to perform LASSO regression to screen the risk factors,and Logistic regression to establish a prediction model and construct a nomogram.The calibration curve and receiver operating characteristic(ROC)curve were used to evaluate the calibration and discrimination of the model.Results LASSO regression analysis ultimately screened five risk factors from 22 variables,and Logistic regression results showed that age,smoking,history of myocardial infarction,New York Heart Association(NYHA)cardiac function class Ⅳ,and left ventricular ejection fraction(LVEF)were all independent risk factors for heart failure in CHD patients(P<0.05).The model formula was Z=-2.927+0.045 × age+0.886 × smoking+0.808 × history of myocardial infarction-2.829 × NYHA cardiac function class Ⅳ+0.037×LVFF.Internal validation of the model showed that area under the curve was 0.727(95%CI:0.588-0.752),the sensitivity was 40.4%,the specificity was 84.3%,and the Youden index was 0.247.According to the calibration curve,the predicted value of the calibration curve was highly consistent with the actual value,and the Brier score was 0.106.Conclusion The risk prediction model for heart failure in patients with CHD based on LASSO regression has good discrimination and prediction efficiency,which can be used as an evaluation tool for medical staff to predict the risk of patients.

Coronary heart diseaseHeart failureNomogramsRisk predictionLASSO regression

徐以康、马晶茹、杨洋、刘蕾、张志峰、孙斯琪、李曼曼、占凯雯

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沈阳医学院附属第二医院心内科,辽宁沈阳 110000

辽宁中医药大学护理学院,辽宁沈阳 110000

冠心病 心力衰竭 列线图 风险预测 LASSO回归

辽宁省科学技术计划项目辽宁省沈阳市科技计划项目

2023-MS-1922-321-33-100

2024

中国现代医生
中国医学科学院

中国现代医生

影响因子:1.571
ISSN:1673-9701
年,卷(期):2024.62(28)