肾上腺病变患者术后并发症的危险因素分析及Nomogram模型构建

Risk factors analysis and Nomogram model construction of postoperative complications in patients with adrenal disease

目的分析肾上腺病变患者进行手术治疗后出现并发症的相关危险因素并构建并发症发生的nomogram预测模型。方法回顾性分析于2019年1月至2021年9月间来我院进行肾上腺肿瘤切除术治疗的366例患者为研究对象,根据术后是否出现并发症分为并发症组(n=41)与非并发症组(n=325)。收集患者的临床资料;通过受试者工作特征(ROC)曲线分析各因素的最佳截断值;采用logistic多元回归模型分析肾上腺肿瘤切除术后出现并发症的独立危险因素;R语言软件4.0“rms”包构建预测肾上腺肿瘤切除术后出现并发症的nomogram预测模型,校正及决策曲线对模型进行内部验证及预测效能评估。结果并发症组女性比例、ASA分级≥3级比例、肿瘤直径、术中出血量、手术时间、住院时间均高于非并发症组。肿瘤直径、术中出血量、手术时间、住院时间的AUC分别为0.818、0.795、0.805、0.815;最佳截断值分别为5.7 cm、43.82 mL、98.23 min、8 d。性别(女)、ASA分级(≥3级)、肿瘤直径(>5.7 cm)、术中出血量(>43.82 mL)、手术时间(>98.23 min)是肾上腺肿瘤切除术后出现并发症的独立危险因素。Nomogram模型预测肾上腺肿瘤切除术后出现并发症的C-index为0.525(95%CI:0.496~0.614),阈值>0.18,Nomogram模型提供临床净收益且临床净收益均高于独立预测因子。结论本研究基于性别、ASA分级、肿瘤直径、术中出血量、手术时间构建了预测肾上腺肿瘤切除术后出现并发症的nomogram模型,该模型可用于早期识别肾上腺肿瘤切除术后发生并发症的危险因素及高风险患者,具有较好的临床效能。

Objective To analyze the risk factors for complications after surgical treatment in patients with adrenal disease and establish a Nomogram prediction model for complications.Methods A retrospective analysis was performed on 366 patients who underwent adrenal tumor resection in our hospital from January 2019 to September 2021.According to postoperative complications,all patients were divided into complication group(n=41)and non-complication group(n=325).The clinical data of patients were collected.The optimum cut-off value of each factor was analyzed by receiver operating characteristic(ROC)curve.Logistic multiple regression model was used to analyze the independent risk factors for complications after adrenal tumor resection.The 4.0“RMS”package of R language software was used to construct a Nomogram prediction model to predict complications after adrenal tumor resection.Calibration and decision curves for internal validation of models and evaluation of predictive performance.Results The proportion of females,the proportion of ASA grade≥3,tumor diameter,intraoperative blood loss,operation time and hospital stay in the complication group were higher than those in the non-complication group.The AUC of tumor diameter,intraoperative blood loss,operative time and length of stay were 0.818,0.795,0.805 and 0.815,respectively.The best truncation values were 5.7 cm,43.82 mL,98.23 min and 8 days,respectively.Gender(female),ASA grade(≥3),tumor diameter(>5.7 cm),intraoperative blood loss(>43.82 mL),and operative time(>98.23 min)were independent risk factors for complications after adrenal tumor resection.The C-index of the Nomogram model for predicting complications after adrenal tumor resection was 0.525(95%CI:0.496~0.614),with a threshold of>0.18.The Nomogram model provided a net clinical benefit and the net clinical benefit was higher than the independent predictors.Conclusion This study constructed a Nomogram model to predict complications after adrenal tumor resection based on gender,ASA grade,tumor diameter,intraoperative blood loss,and operation time.This model can be used to early identify risk factors and high-risk patients for complications after adrenal tumor resection,with good clinical efficacy.