摘要
目的 探究采用新型炎症复合评分系统,建立列线图模型预测腰椎骨折患者术后谵妄的风险。方法 选取2020年6月至2022年12月我院收治并进行手术治疗的251例腰椎骨折患者为研究对象,根据患者情况将其分为术后谵妄组(n=55)和无谵妄组(n=196)。记录两组患者的临床资料并进行单因素分析;ROC曲线分析指标对腰椎骨折患者术后谵妄的预测价值;logistic回归分析术后谵妄的独立危险因素并构建列线图模型,校正曲线对模型进行内部验证,计算一致性指数(concordance index, C-index),决策曲线评估模型预测效能。结果 两组患者在年龄、手术时间、术中出血量、炎症反应标志物NLR、PLR、CAR方面的差异有统计学意义(P <0.05)。年龄、手术时间、术中出血量、NLR、PLR、CAR的AUC分别为0.788、0.714、0.797、0.824、0.839、0.811;构建N.P.Cs评分标准,其AUC为0.963。年龄、术中出血量、N.P.Cs是影响腰椎骨折患者术后谵妄的独立危险因素。列线图预测模型的校正曲线与原始曲线及理想曲线接近,C-index为0.847(95%CI:0.811~0.903);列线图预测模型的阈值> 0.17,可提供临床净收益。结论 年龄、术中出血量、N.P.Cs是影响腰椎骨折患者术后谵妄的独立危险因素,基于此构建的列线图预测模型可为腰椎骨折患者术后谵妄的防治提供指导。
Objective To explore the use of a novel inflammatory composite scoring system with a column chart model to predict the risk of postoperative delirium in patients with lumbar spine fractures.Methods 251 patients with lumbar spine fracture who had been admitted to our hospital and had undergone surgical treatment from June 2020 to December 2022 were selected as study subjects,and then divided into a postoperative delirium group(n=55)and a delirium-free group(n=196)according to the patients'conditions.The clinical data of the two groups were recorded and subjected to univariate analysis.ROC curve was used to analyze the predictive value of the indexes for postoperative delirium in the patients;logistic regression was used to analyse the independent risk factors for postoperative delirium and construct a columnar graph model;the calibration curves were used for the internal validation of the model;the consistency index(C-index)was calculated;and the decision curve was used to evaluate the predictive efficiency of the model.Results The differences between the two groups in terms of age,surgical duration,intraoperative bleeding,and inflammatory response markers NLR,PLR,and CAR were statistically significant(P<0.05).The AUCs of age,surgical time,intraoperative bleeding,NLR,PLR,and CAR were 0.788,0.714,0.797,0.824,0.839,and 0.811,respectively;and the AUC of the constructed N.P.Cs scoring scale was 0.963.Age,intraoperative bleeding,and N.P.Cs were independent risk factors affecting postoperative delirium in patients with lumbar spine fractures.The calibration curve of the column-line diagram prediction model was close to the original and ideal curves,with a C-index of 0.847(95%CI:0.811~0.903);the threshold value of the column-line diagram prediction model was greater than 0.17,providing a net clinical benefit.Conclusion Age,intraoperative bleeding,and N.P.Cs are independent risk factors for postoperative delirium in patients with lumbar spine fractures.The column chart prediction model based on this construction can provi
作者
徐梦馨
王唯
戴荣兄
XU Mengxin;WANG Wei;DAI Rongxiong(The First Affiliated Hospital of Nanjing Medical University(Jiangsu Provincial People's Hospital),Nanjing 210029,China)
出处
《实用医学杂志》
CAS
北大核心
2023年第18期2306-2311,共6页
The Journal of Practical Medicine
关键词
新型炎症复合评分
腰椎骨折
术后谵妄
列线图预测模型
new type of inflammation composite score
lumbar spine fracture
postoperative delirium
column chart prediction model
