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预测ICU获得性衰弱风险的列线图模型的建立和验证 被引量:5

Construction and Validation of a Nomogram Model on Predicting Risk of ICU-acquired Weakness
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摘要 目的:探讨重症监护室获得性衰弱(intensive care unit-acquired weakness,ICU-AW)的独立危险因素,建立个体化预测ICU-AW风险的列线图模型,并评价模型的效能。方法:回顾性分析2018年4月-2021年8月福建省肿瘤医院重症监护室治疗的289例患者的临床资料,采用医学研究理事会(medical research council,MRC)评分评估患者ICU-AW的发生情况。根据是否出现ICU-AW分为ICU-AW组和非ICU-AW组。采用logistic回归分析判断ICU-AW的独立危险因素,建立列线图预测模型,应用受试者工作特征曲线(receiver operating characteristic curve,ROC)、校正曲线对模型进行内部验证。结果:ICU-AW的发生率为33.9%(98/289),多因素分析表明,性别、年龄、急性生理学与慢性健康状况评分、糖皮质激素、神经肌肉阻滞剂、机械通气时间是ICU-AW独立危险因素(P<0.05)。基于独立危险因素建立的列线图模型ROC曲线下面积为0.734,95%CI(0.672,0.796),校正曲线显示原始曲线和理想曲线的一致性较好。Hosmer-Lemeshow检验结果显示拟合优度良好(χ^(2)=6.619,P=0.578)。结论:本研究构建的列线图模型具有良好的精确度和区分度,有利于临床医护人员筛选ICU-AW的高危患者,为制订有效的管理措施提供依据。 Objective:To investigate the independent risk factors of intensive care unit-acquired weakness(ICU-AW),establish an individualized nomogram model to predict the risk of ICU-AW,and evaluate the efficiency of the model.Method:The clinical data of 289 patients treated in the Intensive Care Unit of Fujian Cancer Hospital from April 2018 to August 2021 were retrospectively analyzed,the occurrence of ICU-AW was evaluated by the medical research council(MRC)score.According to the occurrence of ICU-AW,they were divided into ICU-AW group and non-ICU-AW group.The logistic regression analysis were used to determine the independent risk factors of ICU-AW,a nomogram prediction model was established,the receiver operating characteristic curve(ROC)and calibration curve were used to verify the model internally.Result:The incidence of ICU-AW was 33.9%(98/289).Multivariate analysis showed that gender,age,acute physiology and chronic health evaluation(APACHEⅡ)scores,glucocorticoid,neuromuscular resistance delayed agent and duration of mechanical ventilation were independent ideal risk factors for ICU-AW(P<0.05).The area under the ROC curve of the nomogram model based on independent risk factors was 0.734,95%CI(0.672,0.796),and the calibration curve showed that the original curve was in good agreement with the ideal curve.The results of Hosmer-Lemeshow test showed good goodness of fit(χ^(2)=6.619,P=0.578).Conclusion:The nomogram model constructed in this study has good accuracy and discrimination,which is helpful for clinical medical staff to screen high-risk patients with ICU-AW,and provide a basis for formulating effective management measures.
作者 卓冰华 林枝珠 黄海娟 蔡燕清 林振孟 ZHUO Binghua;LIN Zhizhu;HUANG Haijuan;CAI Yanqing;LIN Zhenmeng(Fujian Medical University Cancer Hospital,Fuzhou 350014,China)
出处 《中国医学创新》 CAS 2022年第27期166-170,共5页 Medical Innovation of China
基金 福建省卫生健康科技计划项目(2021TG015)。
关键词 ICU获得性衰弱 列线图 危险因素 Intensive care unit-acquired weakness Nomogram Risk factor
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