脑卒中病人入院后新发抑郁风险的预测模型构建及验证

Construction and validation of a prediction model for the risk of new-onset depression in stroke patients after admission

目的:构建脑卒中病人入院后新发抑郁风险的预测模型,并验证该预测模型的预测效果。方法:选择入院前无抑郁症的脑卒中病人916例,按照入院后1周是否发生抑郁分为新发抑郁组和非抑郁组,采用单因素和多因素logistic回归模型分析新发抑郁的影响因素,建立预测模型,并绘制列线图,同时采用ROC曲线和Hosmer-Lemeshow检验评估模型预测效果。选择2020年4月至2021年4月住院病人298例作为模型验证组。结果:模型构建组和验证组病人的新发抑郁率分别为31.8%和32.9%。年龄、体质量指数、教育程度、家庭人均年收入、睡眠质量、睡眠时间、入院后的照护情况、Barthel指数和NIHSS评分为脑卒中病人入院后新发抑郁的影响因素(P<0.05)。预测模型验证结果显示区分度较好,模型构建组和验证组病人入院后新发抑郁风险的ROC曲线下面积分别为0.868和0.813(P<0.01);同时校准度也较高,2组Hosmer-Lemeshow检验的P值分别为0.817和0.389。结论:构建预测模型可以有效预测脑卒中病人入院后新发抑郁的发生,为临床护理工作中对脑卒中病人进行及时心理干预提供了参考。

Objective:To construct and validate a prediction model for the risk of new-onset depression in stroke patients after admission.Methods:A total of 916 stroke patients who without depression before admission were selected.These patients were divided into the new-onset depression group and the non-depression group according to the occurrence of depression in the first week after admission.Single-factor and multi-factor logistic regression models were used to analyze the influencing factors of new-onset depression and establish the prediction model.Then the nomogram was draw.Meanwhile, the area under the ROC curve and Hosmer-Lemeshow test were used to evaluate the prediction effect of the model.A total of 298 hospitalized patients from April 2020 to April 2021 were selected as the model validation group.Results:The incidence of new-onset depression in the model building group and validation group was 31.8% and 32.9%,respectively.Age, body mass index, education level, per capita annual household income, sleep quality, sleep duration, care after admission, Barthel index and NIHSS score were the influencing factors of new-onset depression in stroke patients after admission(P<0.05).The validation results of the prediction model showed that the discrimination was good.The area under ROC curve of the risk of new-onset depression(P<0.05) after admission was 0.868 in the model construction group and 0.813 in the validation group, respectively(P<0.01).The calibration degree was also high, and the P values of Hosmer-Lemeshow test were 0.817 and 0.389,respectively.Conclusions:The prediction model constructed can effectively predict the occurrence of new-onset depression in stroke patients after admission, providing a reference for timely psychological intervention in clinical nursing work for stroke patients.