神经重症患者暴露性角膜炎风险预测模型的构建及验证

Construction and evaluation of a risk prediction model for Exposure Keratopathy in neurosurgery ICU patients

目的:构建神经重症患者暴露性角膜炎发生风险预测模型,并验证该模型的预测效果。方法:选取2021年1月-4月湖北省某三级甲等医院神经外科ICU的102例患者作为模型建立对象,将其分为暴露性角膜炎组(39例)和非暴露性角膜炎组(63例)。采用Logistic回归分析建立神经重症患者暴露性角膜炎风险预测模型,应用受试者工作特征曲线(ROC曲线)下面积检验模型预测效果,并纳入41例患者对模型进行验证。结果:神经重症患者入ICU 1天内、3天后、7天后暴露性角膜炎发生率分别为38.24%、64.86%、73.91%;其危险因素分别为:眼睑闭合不全、每分钟眨眼反射、眼部其他症状、意识状态。Hosmer-Lemeshow检验P=0.379,ROC曲线下面积为0.925,约登指数最大值为0.773,最佳临界值为0.541,灵敏度为0.821,特异度为0.952,实际应用准确率为97.56%。结论:本模型预测效果良好,可用于预测神经重症患者暴露性角膜炎的发生风险,能为临床医护人员及时识别高危患者并采取预防措施提供参考。

Objective:To construct a risk prediction model for Exposure Keratopathy in neurosurgery ICU patients and to verify the prediction effect of the model.Methods:A total of 102 patients in neurosurgical ICU of a tertiary grade A hospital in Hubei province from January to April 2021 were selected and were divided into the exposed keratitis group(39 cases)and the non-exposed keratitis group(63 cases).Logistic regression was used to establish a risk prediction model for Exposure Keratopathy in neurosurgery ICU patients.The area under Receiver Operating Characteristic(ROC)curve was used to test the prediction effect of the model,and 41 patients were included to verify the model.Results:The incidence of Exposure Keratopathy was 38.24%,64.86%and 73.91%in neurosurgery ICU patients within a day,after 3 days and 7 days in ICU respectively.The influencing factors were:eyelid closure,blink per minute,other eye symptoms,consciousness state.For Hosmer-Lemeshow test,P=0.379,the area under ROC curve of the subjects was 0.925,the Youden index was 0.773,the optimal critical value was 0.541,the sensitivity was 0.821,and the specificity was 0.952.The correct rate of actual application was 97.56%.Conclusion:The model is effective in predicting the risk of Exposure Keratopathy in ICU patients in neurosurgery,and can provide reference for clinical medical staff to identify high-risk patients and take preventive measures in time.