基于入院时临床数据的恙虫病患者并发多器官功能障碍综合征风险的列线图模型建立

Establishment of a nomogram model for multiple organ dysfunction in patients with scrub typhus based on clinical data at admission

目的基于入院时临床数据,分析恙虫病患者并发多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)相关危险因素,建立个体化预测恙虫病患者发生MODS风险的列线图模型。方法采用回顾性研究方法,分析住院治疗的恙虫病患者入院时临床资料,将最终研究对象随机分为建模组(50%)与验证组(50%),建模组数据用于建立二元多因素logistic模型,用R软件绘制列线图,分析患者MODS发生因素。验证组数据用于验证模型。采用ROC曲线和校准图验证列线图模型的预测效能及准确度。结果瘀点或瘀斑(OR=0.001,95%CI:0.00~0.105)、Hb(OR=1.240,95%CI:1.075~1.683)、Plt(OR=1.146,95%CI:1.049~1.400)、ALB(OR=1.865,95%CI:1.317~4.265)、D-二聚体(OR=0.971,95%CI:0.937~0.987)和Pt(OR=0.507,95%CI:0.230~0.765)是患者发生MODS的独立危险因素(P<0.05)。建模组模型ROC曲线的AUC为0.924,验证组ROC曲线的AUC为0.911,两组ROC曲线比较差异无统计学意义(D=1.243,P=0.215)。校准图显示,两组预测模型校准曲线与标准曲线均接近,有统计学意义(P=0.746、0.870,均>0.10)。结论通过瘀点或瘀斑、Hb、Plt、ALB、D-二聚体和Pt独立危险因素,建立的预测恙虫病患者MODS发生风险的列线图模型,具有良好的诊断效能和准确度,对甄别该病患者中的MODS高风险人群,制定干预决策有指导意义。

Objective To analyze the risk factors associated with multiple organ dysfunction syndrome(MODS)of scrub typhus based on clinical data at admission,and to establish a nomogram model for predicting the risk of MODS.Methods The clinical data of scrub typhus patients in four hospital from April 2013 to October 2018 were retrospectively analyzed.The patients were randomly divided into model group(50%)and validation group(50%).The data of model group were used to establish a binary multivariate logistic model,and the nomogram was drawn with R software to analyze the risk factors of MODS.The data of validation group were applied to validate the model.The ROC curve and calibration plot were used to verify the predictive performance and accuracy of the nomogram model.Results Petechiae or ecchymosis(OR=0.001,95%CI:0.00~0.105),Hb(OR=1.240,95%CI:1.075~1.683),Plt(OR=1.146,95%CI:1.049~1.400),Alb(OR=1.865,95%CI:1.317~4.265),D-dimer(OR=0.971,95%CI:0.937~0.987)and Pt(OR=0.507,95%CI:0.230~0.765)were independent risk factors for MODS in scrub typhus patients(P<0.05).The AUC of the ROC curve of the model group was 0.924,and the AUC of the ROC curve of the validation group was 0.911.There was no significant difference between them(D=1.243,P=0.215).The calibration plot of the two groups were significantly concordant with standard curve(P=0.746 and 0.870,respectively,>0.10).Conclusion The nomogram model for predicting the risk of MODS in scrub typhus patients with petechiae or ecchymosis,Hb,plt,alb,D-dimer and Pt as independent risk factors has excellent diagnostic efficacy and accuracy.