住院癌症患者衰弱风险预测模型的构建与验证

Construction and validation of frailty risk prediction model for hospitalized cancer patients

目的调查住院癌症患者发生衰弱的危险因素,构建风险预测模型并检验预测效果。方法选取广州市2所三级甲等医院住院癌症患者570例,分为建模集422例和验证集148例。采用一般资料调查表、Fried衰弱表型、安德森症状评估量表、医院焦虑抑郁量表、中文版失志量表、营养风险筛查2002、Barthel指数量表进行调查,同期收集患者的白细胞介素-6、C-反应蛋白等实验室指标,应用logistic回归分析筛选衰弱的独立危险因素,构建风险预测模型。结果住院癌症患者衰弱发生率为33.7%,衰弱的影响因素分别为:造口、营养状况、抑郁、神经心理症状群、消化道症状群、D-二聚体、白细胞介素-6。建模集和验证集ROC曲线下面积为0.788、0.735;Brier得分为0.205,校准斜率为0.625,决策曲线分析表明模型具有一定的临床可用性。结论住院癌症患者衰弱发生率较高,构建的列线图预测模型具有较好的风险预测价值,可有效识别和筛选住院癌症衰弱高危人群。

Objective To identify the risk factors for frailty in hospitalized cancer patients,and to build a risk prediction model and test the predictive power.Methods Totally,570 cancer patients hospitalized in two class A tertiary hospitals in Guangzhou were selected and divided into a modeling set of 422 and a validation set of 148.A self-designed sociodemographic data questionnaire,the Fried Frailty Phenotype,M.D.Anderson Symptom Inventory,Hospital Anxiety and Depression Scale,Demoralization Scale Mandarin Version,Nutritional Risk Screening 2002 and Barthel Index were used for survey,and the laboratory indicators such as interleukin-6 and C-reactive protein were collected at the same time.Risk factors of frailty in hospitalized cancer patients were identified through logistic regression analysis to determine the risk prediction model.Results The prevalence of frailty in hospitalized cancer patients was 33.7%.The predictors of frailty were stoma,nutritional status,depression,neuropsychological symptom cluster,gastrointestinal symptom cluster,D-dimer and interleukin-6.The area under the ROC curve of the modeling set and validation set was 0.788 and 0.735 respectively.The Brier score was 0.205 and the calibration slope was 0.625.The decision curve analysis de-monstrated that the nomogram was clinically useful.Conclusion The prevalence of frailty in hospitalized cancer patients is relatively high.The nomogram prediction model has satisfactory predictive power,which can be used for identifying and screening frailty in hospitalized cancer patients.