广东医学2026，Vol.47Issue(4)：523-529,7.DOI:10.13820/j.cnki.gdyx.20252747
成人斯蒂尔病患者死亡的风险因素分析及个体化预测方法探讨
Risk factors for mortality in adult-onset Still's disease and development of an individualized nomogram predic-tion model
摘要
Abstract
Objective To identify risk factors for mortality in patients with adult-onset Still's disease(AOSD)and to develop and validate an individualized nomogram for risk prediction.Methods A retrospective study included 213 patients with AOSD treated between January 2018 and December 2024.Patients were randomly split into a training cohort(n=149)and a validation cohort(n=64)at a ratio of 7∶3.In the training cohort,patients were categorized into a death group(n=25)and a survival group(n=124).Clinical variables were compared,and multivariable logistic regression was used to identify independent risk factors for mortality.A nomogram was constructed using R software.Model perform-ance was evaluated by receiver operating characteristic(ROC)curves,calibration plots,and decision curve analysis(DCA).Internal validation was performed using the concordance index(C-index).Results The overall mortality rate was 16.43％(35/213).In the training cohort,patients who died were older and had higher rates of relapse,macrophage activation syndrome(MAS),serum ferritin levels,and pleuritis than survivors(all P＜0.05).Multivariable analysis i-dentified age(OR=1.236,95％CI:1.014-1.507),relapse(OR=3.001,95％CI:1.297-6.944),MAS(OR=3.758,95％CI:1.730-8.167),and pleuritis(OR=2.807,95％CI:1.001-7.869)as independent risk factors for mortality(all P＜0.05).A nomogram incorporating these variables demonstrated excellent discrimination,with AUCs of 0.936(95％CI:0.884-0.970)in the training cohort and 0.847(95％CI:0.779-0.901)in the validation cohort.The C-index values were 0.917 and 0.845,respectively.Calibration curves showed good agreement between predicted and observed risks(Hosmer-Lemeshow test,P＞0.05).DCA indicated that the model provided clinical net benefit across a wide range of threshold probabilities.Conclusion Age,relapse,MAS,and pleuritis are independent risk fac-tors for mortality in patients with AOSD.The proposed nomogram demonstrates good predictive performance and may assist in individualized risk stratification and clinical decision-making.关键词
成人斯蒂尔病/死亡/风险因素/预测效能/Nomogram模型Key words
adult-onset Still's disease/mortality/risk factors/predictive performance/nomogram model分类
医药卫生引用本文复制引用
王晓莹,杨晓佩,王喜甲,张磊,刘升云..成人斯蒂尔病患者死亡的风险因素分析及个体化预测方法探讨[J].广东医学,2026,47(4):523-529,7.基金项目
河南省医学适宜技术推广项目(SYJS2022099,SYJS2022100) （SYJS2022099,SYJS2022100）
