北京大学学报（医学版）2024，Vol.56Issue(5)：874-883,10.DOI:10.19723/j.issn.1671-167X.2024.05.019
老年髋部骨折患者住院期间发生术后心力衰竭的列线图预测模型的构建及验证
Construction and validation of a nomogram for predicting in-hospital postoperative heart failure in elderly patients with hip fracture
摘要
Abstract
Objective:To construct and validate a nomogram for prediction of in-hospital postoperative heart failure(PHF)in elderly patients with hip fracture.Methods:This was a retrospective cohort study.The patients aged ≥65 years undergoing hip fracture surgery in Peking University Third Hospital from July 2015 to December 2023 were enrolled.The patients admitted from July 2015 to December 2021 were divided into a development cohort,and the others admitted from January 2022 to December 2023 in to a validation cohort.The patients'clinical data were collected from the electronic medical record sys-tem.Univariate and multivariate Logistic regression were employed to screen the predictors for PHF in the patients.The R software was used to construct a nomogram.Internal and external validation were per-formed by the Bootstrap method.The discriminatory ability of the model was determined by the area un-der the receiver operating characteristic curve(AUC).The calibration was evaluated by the calibration plot and Hosmer-Lemeshow goodness-of-fit test.Decision curve analysis(DCA)was performed to assess the clinical utility.Results:In the study,944 patients were eventually enrolled in the development co-hort,and 469 were in the validation cohort.A total of 54(5.7％)patients developed PHF in the deve-lopment cohort,and 18(3.8％)patients had PHF in the validation cohort.Compared with those from non-PHF group,the patients from PHF group were older,had higher prevalence of heart disease,hyper-tension and pulmonary disease,had poorer American Society of Anesthesiologists(ASA)classification(Ⅲ-Ⅳ),presented with lower preoperative hemoglobin level,lower left ventricular ejection fraction,higher preoperative serum creatinine,received hip arthroplasty and general anesthesia more frequently.Multivariate Logistic regression analysis showed that age(OR=1.071,95％CI:1.019-1.127,P=0.008),history of heart disease(OR=5.360,95％CI:2.808-10.234,P＜0.001),preoperative he-moglobin level(OR=0.979,95％CI:0.960-0.999,P=0.041),preoperative serum creatinine(OR=1.007,95％CI:1.001-1.013,P=0.015),hip arthroplasty(OR=2.513,95％CI:1.259-5.019,P=0.009),and general anesthesia(OR=2.024,95％CI:1.053-3.890,P=0.034)were the independent predictors for PHF in elderly patients with hip fracture.Four preoperative predictors were incorporated to construct a preoperative nomogram for PHF in the patients.The AUC values of the nomo-gram in internal and external validation were 0.818(95％CI:0.768-0.868)and 0.873(95％CI:0.805-0.929),indicating its good accuracy.The calibration plots and Hosmer-Lemeshow goodness-of-fit test(internal validation:x2=9.958,P=0.354;external validation:x2=5.477,P=0.791)showed its satisfactory calibration.Clinical usefulness of the nomogram was confirmed by decision curve analysis.Conclusion:An easy-to-use nomogram for prediction of in-hospital PHF in elderly patients with hip fracture is well developed.This preoperative risk assessment tool can effectively identify patients at high risk of PHF and may be useful for perioperative management optimization.关键词
老年人/髋部骨折/心力衰竭/列线图Key words
Elderly/Hip fracture/Heart failure/Nomograms分类
医药卫生引用本文复制引用
刘园梅,傅义程,郝靖欣,张福春,刘慧琳..老年髋部骨折患者住院期间发生术后心力衰竭的列线图预测模型的构建及验证[J].北京大学学报（医学版）,2024,56(5):874-883,10.基金项目
慢性病防治与健康教育研究项目(BJMB0012023024006)和北京大学第三医院临床重点项目(BYSYDL2021022)Supported by the Chronic Disease Prevention and Health Education Research Project(BJMB0012023024006)and the Key Clinical Program of Peking University Third Hospital(BYSYDL2021022) （BJMB0012023024006）
