药物性肝损伤患者预后影响因素分析及列线图模型的建立OACSTPCD
Influencing factors for the prognosis of patients with drug-induced liver injury and establishment of a nomogram model
目的 探讨药物性肝损伤(DILI)患者临床转归的影响因素,构建列线图模型并进行内部验证.方法 回顾性分析哈尔滨工业大学附属黑龙江省医院2017年1月—2022年12月收治的188例DILI患者的一般资料和实验室数据,根据患者临床转归分为结局良好组(n=146)和不良结局组(n=42).正态分布计量资料两组间比较采用成组t检验;非正态分布计量资料两组间比较采用Mann-Whitney U检验.计数资料两组间比较采用χ2检验.通过单因素和多因素Logistic回归分析筛选DILI患者临床转归相关的独立影响因素.R Studio 4.1.2软件构建列线图模型,通过校准曲线、受试者工作特征曲线(ROC曲线)和决策曲线分析(DCA)对模型进行内部验证.结果 单因素Logistic回归分析结果显示,肝活检诊断DILI、PLT、ChE、Alb、PTA、IgM和IgG与DILI患者不良结局相关(P值均<0.05).多因素Logistic回归分析结果显示,肝活检诊断DILI(OR= 0.072,95%CI:0.022～0.213,P<0.001)、临床分型(OR=0.463,95%CI:0.213～0.926,P=0.039)、ALT(OR=0.999,95%CI:0.998～1.000,P=0.025)、PTA(OR=0.973,95%CI:0.952～0.993,P=0.011)和IgM(OR=1.456,95%CI:1.082～2.021,P= 0.015)是DILI患者临床转归的独立影响因素.构建列线图,经验证校准曲线接近参考曲线,ROC曲线下面积为0.829,决策曲线分析显示该模型具有良好的临床净收益.结论 构建的列线图模型对评估DILI患者的临床转归具有较好的临床校准度、鉴别能力和应用价值.
Objective To investigate the influencing factors for the clinical outcome of patients with drug-induced liver injury(DILI),and to establish a nomogram prediction model for validation.Methods A retrospective analysis was performed for the general information and laboratory data of 188 patients with DILI who were admitted to Heilongjiang Provincial Hospital Affiliated to Harbin Institute of Technology from January 2017 to December 2022,and according to their clinical outcome,they were divided into good outcome group with 146 patients and poor outcome group with 42 patients.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.Univariate and multivariate Logistic regression analyses were used to investigate the independent influencing factors for the clinical outcome of DILI patients.R Studio 4.1.2 software was used to establish a nomogram model,and calibration curve,receiver operating characteristic(ROC)curve,and decision curve analysis(DCA)were used to perform internal validation.Results The univariate Logistic regression analysis showed that liver biopsy for the diagnosis of DILI,platelet count,cholinesterase,albumin,prothrombin time activity,IgM,and IgG were associated with adverse outcomes in patients with DILI.The multivariate Logistic regression analysis showed that liver biopsy for the diagnosis of DILI(odds ratio[OR]=0.072,95%confidence interval[CI]:0.022—0.213,P<0.001),clinical classification(OR=0.463,95%CI:0.213—0.926,P=0.039),alanine aminotransferase(OR=0.999,95%CI:0.998—1.000,P=0.025),prothrombin time activity(OR=0.973,95%CI:0.952—0.993,P=0.011),and IgM(OR=1.456,95%CI:1.082—2.021,P=0.015)were independent influencing factors for clinical outcome in patients with DILI.The nomogram prediction model was established,and after validation,the calibration curve was close to the reference curve.The area under the ROC curve was 0.829,and the DCA curve showed that the model had good net clinical benefit.Conclusion The nomogram prediction model established in this study has good clinical calibration,discriminative ability,and application value in evaluating the clinical outcome of patients with DILI.
王诗美;靳帅;李俊儒;王娜;陈岩;崔莹;马明明;胡晓丽
哈尔滨工业大学附属黑龙江省医院感染科,哈尔滨 150036贵州医科大学大健康学院,贵阳 550025哈尔滨工业大学附属黑龙江省医院药学部,哈尔滨 150036
化学性与药物性肝损伤预后列线图
Chemical and Drug Induced Liver InjuryPrognosisNomograms
《临床肝胆病杂志》 2024 (003)
562-567 / 6
黑龙江省卫生健康委科研课题(20210303080081);黑龙江省博士后科研启动基金(LBH-Q20056) Scientific Research Project of Health Commission of Heilongjiang Province(20210303080081);Heilongjiang Postdoctoral Scientific Research Development Fund(LBH-Q20056)
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