急性胰腺炎非重症患者住院时间延长预测模型的构建及验证

Construction and verification of predictive model for prolonged length of stay in patients with non-severe acute pancreatitis

目的构建急性胰腺炎非重症患者住院时间延长预测模型并进行验证,为临床管理和护理指导提供依据。方法选取大理州某三级甲等医院2018年1月—2021年12月980例急性胰腺炎非重症患者,按住院时间分为住院时间未延长组和延长组,应用二元Logistic回归分析构建预测模型,采用Hosmer-Lemeshow检验、受试者工作特征曲线(ROC)和约登指数验证模型的区分度、一致性和临床有用性。结果最终纳入文化情况、饮食习惯(不良饮食类别)、白细胞、丙氨酸、天冬氨酸、Morse跌倒评估得分6个独立影响因素,最终得到预测模型:Z=-2.357-0.276×文化情况+2.248×饮食习惯(不良饮食类别)+0.095×白细胞+0.014×丙氨酸-0.009×天冬氨酸+0.018×Morse跌倒评估得分,AUC为0.789,95%CI(0.733,0.845),约登指数最大值为0.512,灵敏度为0.656,特异度为0.856。验证模型结果:灵敏度为0.775,特异度为0.937,准确率为93.9%。结论该模型能较好地预测急性胰腺炎非重症患者住院时间延长的发生风险,为临床管理和护理指导提供依据。

Objective To construct and verify the predictive model for a prolonged length of stay(LOS)in patients with non-severe acute pancreatitis,and provide reference for clinical management and nursing guidance.Methods A total of 980 patients with non-severe acute pancreatitis from January 2018 to December 2021 in a tertiary grade-A hospital in Dali were enrolled in this research and were divided into non-prolonged LOS group and prolonged LOS group.Duality logistic regression analysis was used to construct a predictive model.Hosmer-Lemeshow test,receiver operating characteristic curve(ROC)and Youden index were used to verify the differentiation,consistency and clinical usefulness of the model.Results Six independent influencing factors of education background,dietary habit(unhealthy diet category),white blood cells,alanine,aspartic and Morse Fall score were included in this research.The final predictive model was Z=-2.357-0.276×education background+2.248×dietary habit(unhealthy diet category)+0.095×WBC+0.014×alanine-0.009×aspartic+0.018×Morse score;the area under the ROC curve(AUC)=0.789,95%CI(0.733,0.845);the maximum Youden index was 0.512;the sensitivity 0.656,and the specificity 0.856.Verification model showed that the sensitivity was 0.775;the specificity 0.937,and the accuracy 93.9%.Conclusion This model could predict the risk of prolonged LOS in patients with non-severe acute pancreatitis,which could provide reference for clinical management and nursing guidance.