维持性血液透析患者死亡危险因素Logistic回归分析及预测模型构建

Logistic Regression Analysis and Predictive Model Construction of Risk Factors for Death in Maintenance Hemodialysis Patients

目的研究维持性血液透析患者死亡的危险因素,采用Logistic回归分析计算构建维持性血液透析患者预后的模型。方法方便选取2020年1月—2021年7月期间该院收治的436例终末期肾病患者作为研究对象,所有患者均进行维持性血液透析治疗。对患者随访2年,观察患者存活情况。将死亡组患者与存活组患者临床资料进行对比,分析两组患者临床资料的差异性,将有差异项目代入Logistic回归方程计算,分析维持性血液透析患者死亡的危险因素。通过各危险因素的权重系数和变量类型,创建预测维持性血液透析患者死亡风险的评分标准。结果436例患者随访2年,其中存活患者129例(29.59%),死亡307例(70.41%)。存活组与死亡组患者在年龄、原发病、恶性肿瘤、血管通路、血清白蛋白以及血钙水平上对比差异有统计学意义(P<0.05)。将存活组和死亡组患者有差异资料代入Logistic回归方程计算,结果发现年龄、原发病、恶性肿瘤、血管通路以及血钙均是维持性血液透析患者死亡的危险因素(OR=1.486、1.514、1.649、1.433、1.548),血清白蛋白是其保护因素(OR=0.663)。根据Logistic回归分析和危险因素赋值进行维持性血液透析患者死亡危险因素的数学模型构建,得出ODDS=Exp[(0.724×年龄赋值)+0.729×原发病赋值+0.680×恶性肿瘤赋值+0.687×血管通路赋值-0.707×白蛋白赋值+0.680×血钙赋值]。预测病死率=ODDS/(ODDS+1)×100%。结论维持性血液透析患者死亡的危险因素包括年龄、原发病、恶性肿瘤、血管通路和血钙水平,血清白蛋白是其保护因素。通过危险因素构建预测模型预测患者病死率对临床评估患者预后具有重要意义。

Objective To study the risk factors of death in maintenance hemodialysis patients,and use Logistic regression analysis to calculate and construct a prognostic model of maintenance hemodialysis patients.Methods 436 patients with end-stage renal disease admitted to the hospital from January 2020 to July 2021 were conveniently selected as the research objects,and all patients were treated with maintenance hemodialysis.The patients were followed up for 2 years to observe their survival.The clinical data of the patients in the death group and the survival group were compared,the differences in the clinical data of the two groups were analyzed,and the difference items were substituted into the Logistic regression equation to calculate the risk factors of death in maintenance hemodialysis patients.Through the weight coefficients and variable types of various risk factors,a scoring standard for predicting the risk of death in maintenance hemodialysis patients was created.Results 436 patients were followed up for 2 years,of which 129 patients(29.59%)survived and 307 patients died(70.41%).The survival group and the death group had statistically significant differences in age,primary disease,malignant tumor,vascular access,serum albumin and blood calcium levels(P<0.05).Substitute the difference data between the survival group and the death group into the Logistic regression equation to calculate.The results showed that age,primary disease,malignant tumors,vascular access,and blood calcium were all risk factors for death in maintenance hemodialysis patients(OR=1.486,1.514,1.649,1.433,1.548),and serum albumin was the protective factor(OR=0.663).According to Logistic regression analysis and the assignment of risk factors,the mathematical model of the death risk factors of maintenance hemodialysis patients was constructed.Obtain ODDS=Exp[(0.724×age assignment)+0.729×primary disease assignment+0.680×malignant tumor assignment+0.687×vascular access assignment-0.707×albumin assignment+0.680×serum calcium assignment].Predicted mortality=ODDS/(ODDS+1)×100%.Conclusion The risk factors for death of maintenance hemodialysis patients include age,primary disease,malignant tumor,vascular access and blood calcium level,and albumin is its protective factor.Constructing a predictive model through risk factors to predict patient mortality is of great significance for clinical assessment of patient prognosis.