汕头大学医学院学报2024，Vol.37Issue(3)：129-135,7.DOI:10.13401/j.cnki.jsumc.2024.03.001
急性胰腺炎患者院内病死风险预测模型的建立与评价
Establishment and evaluation of a predictive model for the risk of in-hospital mortality in patients with acute pancreatitis
摘要
Abstract
Objective:To investigate the factors associated with in-hospital mortality in patients with acute pancreatitis in the intensive care unit(ICU),and to construct a nomogram prediction model for mortality risk.Methods:520 patients with acute pancreatitis admitted to the ICU were extracted from the U.S.Medical Information Mart for Intensive Care-Ⅳ database and randomized in a 7:3 ratio into a training set(n=364)and a validation set(n=156).There were 210(57.7％)males and 154(42.3％)females in the training set with an age of 57.9(45.9,72.4)years,and 87(55.8％)males and 69(44.2％)females in the validation set with an age of 54.6(42.0,70.3)years.Logistic regression analysis was utilized to screen for factors associated with in-hospital mortality in patients with acute pancreatitis,and a nomogram prediction model was constructed.The discrimination of the model was assessed by the area under curve(AUC)of receiver operating characteristic(ROC).The calibration of the model was assessed using the Hosmer-Lemeshow test and calibration curve.Decision curve analysis was used to assess the clinical applicability of the predictive model.Results:A total of 7 predictors were screened,including age(OR=1.057,95％CI:1.024-1.091),myocardial infarction(OR=4.152,95％CI:1.576-10.937),severe liver disease(OR=11.73,95％CI:3.291-42.190),sepsis(OR=14.354,95％CI:4.612-44.675),white blood cell count(OR=1.056,95％CI:1.006-1.108),red cell volume distribution width(OR=1.258,95％CI:1.002-1.579),and activated partial thromboplastin time(OR=1.031,95％CI:1.013-1.050)were factors associated with in-hospital mortality in patients with acute pancreatitis.A nomogram prediction model was constructed based on the above 7 predictors.The ROC curves showed that the AUC values of this model for predicting death in the training and validation sets were 0.916 and 0.891,respectively,which were greater than those of the simplified acute physiology scoreⅡ(SAPSⅡ),acute physiology score Ⅲ(APSⅢ),and the Oxford acute severity of illness score(OASIS)(0.838 and 0.857,0.808 and 0.831,0.776 and 0.759,respectively).It showed that nomogram prediction model was well discriminated and had better predictive performance than the SAPSⅡ,APSⅢ,and OASIS.The calibration curves showed that the model predicted in-hospital morbidity with good agreement with the actual results in both the training and validation sets.Decision curves showed that using this nomogram model to predict in-hospital morbidity in patients with acute pancreatitis provided a greater net benefit than the SAPSⅡ,APSⅢ,and OASIS scores when the threshold probability ranged from 20％to 78％.Conclusion:A nomogram model constructed based on age,myocardial infarction,severe liver disease,sepsis,white blood cell count,red cell volume distribution width,and activated partial thromboplastin time is effective in predicting in-hospital morbidity in patients with acute pancreatitis,and it has good clinical utility.关键词
急性胰腺炎/院内病死/美国重症监护医学信息数据库Ⅳ/预测模型Key words
acute pancreatitis/in-hospital mortality/MIMIC-Ⅳ database/prediction model分类
医药卫生引用本文复制引用
陈春露,杨晓寰,吴晓佳,陈翠红,蔡敏华,许学强,蔡先彬..急性胰腺炎患者院内病死风险预测模型的建立与评价[J].汕头大学医学院学报,2024,37(3):129-135,7.基金项目
汕头大学医学院第一附属医院英才计划基金(YCTJ-2023-07) （YCTJ-2023-07）
