单段枸橼酸钠用于血液透析治疗凝血的危险因素及预测模型建立

Risk factors and prediction model of single-stage sodium citrate in hemodialysis

目的探讨单段枸橼酸钠用于血液透析(hemodialysis,HD)治疗凝血的危险因素并建立预测模型。方法回顾分析南昌大学第二附属医院2018年1月至2021年7月因存在高危出血风险使用单段法的240例患者640例次HD治疗,分析抗凝治疗过程的相关参数,单因素及多因素logistic回归分析凝血的危险因素,根据logistic回归分析结果建立风险预测模型,应用R语言建立预测模型的列线图,采用ROC曲线分析回归模型的预测价值。结果640例次单段法凝血的比例为25.93%。logistic回归分析显示血管通路、总超滤量、枸橼酸钠泵入速度与血流量比值(T/Q)、饮食、2 h B点游离Ca^(2+)浓度、静脉压为凝血的独立危险因素,据此建立单段法HD治疗的预测模型,应用ROC曲线分析方法得出AUC为0.996,0.661为截断点,灵敏度为0.983,特异度为0.994。结论应用logistic回归模型对凝血风险建立的模型对单段法HD治疗是否发生凝血可作出初步判断。

Objective To investigate the risk factors of single-stage sodium citrate for coagulation in hemodialysis(HD),and to establish a prediction model.Methods A total of 240 patients with high-risk bleeding who received 640 HD treatments in the Second Affiliated Hospital of Nanchang University from January 2018 to July 2021 were retrospectively analyzed.The relevant parameters of anticoagulant treatment were analyzed.The risk factors of coagulation were analyzed by univariate and multivariate logistic regression.The risk prediction model was established according to the results of logistic regression analysis,the nomogram of the prediction model was established by R language,and the receiver operator characteristic curve(ROC)was used to analyze the prediction value of the regression model.Results The proportion of 640 cases with single-stage coagulation was 25.93%.Logistic regression analysis showed that vascular pathway,total ultrafiltration volume,ratio of sodium citrate pumping speed to blood flow(T/Q),diet,2 h B free Ca^(2+) concentration and venous pressure were independent risk factors for coagulation.The prediction model of single-stage HD treatment was established based on the above findings.Using ROC curve analysis,the area under curve(AUC)was 0.996 and 0.661 was the cut-off point,the sensitivity was 0.983 and the specificity was 0.994.Conclusion The model of coagulation risk established by logistic regression model could make a preliminary judgment on coagulation occurs in single-stage HD treatment.