终末期肾病新入血液透析患者再住院影响因素及其风险预测模型OACSTPCD
Influencing Factors and Risk Prediction Model of Re-hospitalization in Pa-tients with End-stage Renal Disease Newly Admitted to Undergo Hemodial-ysis
目的 探讨终末期肾病(ESRD)新入血液透析患者再住院的影响因素,据此构建风险预测模型.方法 选取2015 年1 月—2020 年5 月ESRD新入血液透析194 例,根据透析1 年内有无再住院分为住院组(113 例)与非住院组(81 例).收集2 组临床资料,采用多因素Logistic和Lasso回归分析ESRD新入血液透析患者再住院的影响因素,利用列线图构建其风险预测模型,校正曲线和受试者工作特征(ROC)曲线对风险预测模型进行评估.结果 住院组与非住院组年龄、体质量指数(BMI)、糖尿病肾病、血管通路、血尿素、血肌酐、血尿素下降率、肾小球滤过率(eGFR)、血红蛋白(Hb)、白蛋白(Alb)、B型脑钠肽(BNP)、C反应蛋白(CRP)、血清铁蛋白、尿素清除指数(KT/V)比较,差异有统计学意义(P＜0.05,P＜0.01).将上述指标纳入Lasso回归分析,得出 10 个因素:年龄、BMI、糖尿病肾病、血管通路、eGFR、Hb、Alb、BNP、CRP、KT/V.年龄、糖尿病肾病、血管通路为导管、BNP、CRP是ESRD新入血液透析患者再住院的独立危险因素,BMI、eGFR、Hb、Alb、KT/V是其独立保护因素(P＜0.05,P＜0.01).基于以上因素构建患者再住院的风险预测模型,校正曲线、ROC曲线评估该模型具有较高一致性和预测价值.结论 ESRD新入血液透析患者再住院影响因素包括年龄、BMI、糖尿病肾病、血管通路、eGFR、Hb、Alb、BNP、CRP、KT/V,利用上述因素构建患者再住院风险预测模型,该模型具有较高预测价值.
Objective To investigate the influencing factors of re-hospitalization in patients with end-stage renal dis-ease(ESRD)newly admitted to undergo hemodialysis,so as to establish a risk prediction model.Methods A total of 194 patients with ESRD newly admitted to undergo hemodialysis from January 2015 to May 2020 were selected and divided into in-patient group(n=113)and non-inpatient group(n=81)according to whether they were re-hospitalized within 1 year of he-modialysis.Clinical data of the two groups were collected.Multivariate Logistic and Lasso regression were used to analyze the influencing factors of re-hospitalization in patients with ESRD newly admitted to undergo hemodialysis.The risk prediction model was constructed by using the nomogram.The correction curve and receiver operating characteristic(ROC)curve were used to evaluate the risk prediction model.Results There were significant difference in age,body mass index(BMI),dia-betic nephropathy,vascular pathways,blood urea nitrogen(BUN),blood creatinine,decline rate of BUN,estimated glomer-ular filtration rate(eGFR),hemoglobin(Hb),albumin(Alb),brain type B natriuretic peptide(BNP),C reactive protein(CRP),serum ferritin,urea clearance index(KT/V)between inpatient group and non-inpatient group(P＜0.05,P＜0.01).The above indicators were included in Lasso regression analysis,and 10 factors were obtained:age,BMI,diabetic nephropathy,vascular access,eGFR,Hb,Alb,BNP,CRP,and KT/V.Age,diabetic nephropathy,catheter access,BNP and CRP were independent risk factors for re-hospitalization in patients with ESRD newly admitted to undergo hemodialysis,while BMI,eGFR,Hb,Alb and KT/V were independent protective factors(P＜0.05,P＜0.01).Based on the above fac-tors,a risk prediction model for patient re-hospitalization was constructed.Correction curve and ROC curve assessed that the model had high consistency and predictive value.Conclusion The influencing factors of re-hospitalization of patients with ESRD newly admitted to undergo hemodialysis include age,BMI,diabetic nephropathy,vascular access,eGFR,Hb,Alb,BNP,CRP and KT/V.Using the above factors,a prediction model of patient re-hospitalization was constructed,which has high predictive value.
张健美;李亚光;李慧妍
066000 河北 秦皇岛,秦皇岛市第一医院血液透析室
临床医学
终末期肾病血液透析再住院影响因素列线图肾小球滤过率糖尿病肾病C反应蛋白
End-stage renal diseaseHemodialysisRe-hospitalizationInfluencing factorsNomogramsGlomeru-lar filtration rateDiabetic nephropathiesC reactive protein
《临床误诊误治》 2024 (004)
35-41 / 7
秦皇岛市科学技术研究与发展计划(202004A101)
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