摘要
目的:分析并筛选心脏移植(heart transplant,HT)术后发生急性肾损伤的危险因素,建立预测HT术后早期发生急性肾损伤(acute kidney injury,AKI)的动态列线图预测模型。方法:回顾性分析2012年10月至2024年6月在南京市第一医院接受HT术受者的临床资料,根据术后7 d内是否发生AKI分为AKI组和非AKI组,按8∶2划分训练集和测试集。采用Lasso回归和多因素Logistic回归筛选影响因素,通过R建立可视化的动态列线图模型。采用Bootstrap法重复抽样1 000次,对模型进行内部验证。使用受试者工作特征曲线下面积(AUC-ROC)、校准曲线、Hosmer-Lemeshow拟合优度检验评价模型的准确性和区分度,并将列线图模型同Cleveland评分进行对比。结果:多因素Logistic回归结果显示,房颤史(OR=9.647,95%CI=1.961~47.470)、术中血管活性药物评分(OR=1.094,95%CI=1.012~1.183)、术中输入红细胞或血浆(OR=10.200,95%CI=1.727~60.238)、术后中心静脉压(OR=1.548,95%CI=1.186~2.021)和术后使用万古霉素(OR=25.082,95%CI=2.122~296.417)是心脏移植后急性肾损伤(HT-AKI)的5个独立危险因素,动态列线图模型在测试集中AUC=0.842(95%CI:0.676~0.971),校准曲线为斜率接近1的斜线,Brier评分为0.173;Hosmer-Lemeshow拟合优度检验(χ2=5.658,P=0.685)提示模型预测性能较好。且本模型显示出比Cleveland评分更好的区分度。结论:本研究发现了影响HTAKI的术前、术中、术后的重要危险因素,建立的动态列线图模型能够较准确识别AKI高风险人群,并方便临床使用。
AIM:To analyze and screen the risk factors for acute kidney injury(AKI)following heart transplantation(HT),and to establish a dynamic no-mograms prediction model to forecast early AKI af-ter HT.METHODS:A retrospective analysis was con-ducted on clinical data from HT recipients at Nan-jing First Hospital from October 2012 to June 2024.Patients were divided into AKI and non-AKI groups based on AKI occurrence within 7 days post-sur-gery,with a 8:2 ratio for training and testing sets.Lasso regression and multivariable logistic regres-sion were used to select influencing factors.A dy-namic nomogram model was visualized using R.In-ternal validation was performed using 1000 boot-strap samples.Model accuracy and discrimination were evaluated using the area under the receiver operating characteristic curve(AUC-ROC),calibra-tion curves,and the Hosmer-Lemeshow goodness-of-fit test.The nomogram model was compared with the Cleveland score.RESULTS:The results of a multivariable logistic regression indicate that a his-tory of atrial fibrillation(OR=9.647,95%CI=1.961-47.470),vasoactive inotropic score(OR=1.094,95%CI=1.012-1.183),intraoperative transfusion of red blood cells or plasma(OR=10.200,95%CI=1.727-60.238),postoperative central venous pressure(OR=1.548,95%CI=1.186-2.021),and postoperative use of vancomycin(OR=25.082,95%CI=2.122-296.417)are independent risk factors for HT-AKI.The dynamic nomogram model achieved an AUC of 0.842(95%CI:0.676-0.971)in the test set,with a calibration plot showing a slope close to 1 and a Brier score of 0.173.The Hosmer-Lemeshow good-ness-of-fit test(χ2=5.658,P=0.685)suggests good predictive performance of the model.Moreover,this model demonstrates superior discriminative ability compared to the Cleveland score.CONCLU-SION:This study identified preoperative,intraoper-ative,and postoperative risk factors influencing the occurrence of HT-AKI.The developed dynamic no-mogram model accurately identifies high-risk indi-viduals for early HT-AKI and is convenient for clini-cal use.
作者
陈烨
蒋英硕
朱新悦
杜文心
陈鑫
娄晟
孙建国
朱君荣
CHEN Ye;JIANG Yingshuo;ZHU Xinyue;DU Wenxin;CHEN Xin;LOU Sheng;SUN Jian-guo;ZHU Junrong(Department of Pharmacy,Nanjing First Hospital,China Pharmaceutical University,Nanjing 210006,Jiangsu,China;Department of Pharmacy,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,Jiang-su,China;Department of Cardiothoracic Surgery,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,Jiangsu,China;Key Laboratory of Drug Metabolism and Pharmacokinetics,China Pharmaceutical University,Nanjing 210009,Jiangsu,China)
出处
《中国临床药理学与治疗学》
CAS
CSCD
北大核心
2024年第11期1272-1279,共8页
Chinese Journal of Clinical Pharmacology and Therapeutics
基金
江苏省老年医学学会2023年度临床药学专项基金科研项目(JGS2023ZDYX003)。
关键词
心脏移植
急性肾损伤
预测模型
动态列线图
heart transplantation
acute kidney injury
prediction model
dynamic nomogram
