腹部手术患者压力性损伤风险预测模型的开发及验证

Development and validation of a nomogram for predicting the risk of pressure injury in adult patients undergoing abdominal surgery

目的旨在开发腹部手术患者压力性损伤风险预测诺谟图模型并验证其对预测准确性。方法回顾性收集2017年1月至2020年12月期间在中国西部1所医院普通外科进行腹部外科手术且术后在ICU进行重症监护治疗的11247例患者病历,并从病历中提取患者一般资料、术前和术中相关资料、压力性损伤发生情况等。根据手术后患者是否发生压力性损伤对病例进行区分,所有数据根据R软件按8∶2的比例随机分为训练队列(n=8997)及验证队列(n=2250)。对训练队列中的数据采用单因素及多因素logistic回归分析,开发腹部手术患者压力性损伤风险预测诺谟图模型。结果共有873例患者(7.8%)发生了压力性损伤。Logistic回归分析显示,手术时间、体重、手术类型、术前白蛋白、Braden量表评分是压力性损伤发生的独立危险因素,据此构建诺谟图。研究结果显示,该诺谟图用于压力性损伤预测的受试者工作曲线的曲线下面积为0.831,特异性为85.2%,敏感性为63.7%;Braden量表的曲线下面积则为0.567,特异性为33.0%。诺谟图的Hosmer-Lemeshow检验P值为0.45,Braden量表的Hosmer-Lemeshow检验P值为0.22,两者均显示了较好的校准度。在决策曲线分析中,诺谟图也显示了更好的预测效果。结论与Braden评分相比,本研究所构建的诺谟图模型对于腹部手术患者压力性损伤显示出更好的预测效果。尽管这些结果还需要进一步的验证,诺谟图能提供更有效的信息,有潜力为临床护理对于压力性损伤的分级及预防提供帮助。

Objectives:This study aimed to develop a nomogram for predicting the risk of pressure injury(PI)in adult patients undergoing abdominal surgery and validate its effectiveness among these patients.Methods:This study retrospectively included 11,247 adult patients,who underwent abdominal surgery and postoperative supervision in ICU,in a tertiary care hospital in western China between January 2017 and December 2020.All datasets were extracted from the patient’s medical records and randomly divided into the training cohort(8,997)and the validation cohort(2,250)by 8:2.The univariable logistic regression was used to select potentially relevant features.Then,multivariable logistic regression was also conducted and utilized to establish the nomogram.The nomogram was compared with the Braden scale for predicting PI in the validation cohort through the area under the curve(AUC)of the receiver operator characteristic(ROC)curve,Hosmer-Lemeshow(H-L)test,and decision curve analysis(DCA).Results:873(7.8%)patients suffered PIs.Logistic regression analysis showed that time of operation,weight,type of operation,albumin,and Braden scale score were independent risk factors for PI.A nomogram integrating five selected characteristics was constructed.The AUC of the ROC curve for the nomogram was 0.831,with a specificity of 85.2%and sensitivity of 63.7%.The AUC of the ROC curve for the Braden scale was 0.567,with a specificity of only 33.0%.The P-values of the H-L test were 0.45(nomogram)and 0.22(Braden scale),both indicating good calibration.The DCA also displayed that the nomogram had better predictive validity.Conclusion:Compared with the Braden scale,the nomogram showed a better predictive performance.This nomogram is informative and has the potential to better guide caregivers for risk stratification and prevention of PI,although it requires further validation.