慢性肾脏病住院患者营养不良的危险因素分析和预测模型构建

Risk factor analysis and prediction model construction for malnutrition in chronic kidney disease inpatients

目的探究慢性肾脏病(chronic kidney disease,CKD)住院患者的营养不良现状,分析其影响因素并构建预测模型,为中国CKD住院患者的临床营养支持与干预治疗提供本土化理论依据和更加便捷的风险预测指标及模型。方法采取便利抽样,选取2019年1月-10月四川大学华西医院肾脏内科的CKD住院患者为研究对象,采取一般资料问卷、营养风险筛查2002量表、华西心晴指数问卷进行调查,采用单因素分析、多因素logistic回归分析探讨CKD住院患者营养不良的危险因素,并建立预测模型进行受试者操作特征曲线分析、Bootstrap多次拟合验证。结果共发放1118份问卷,回收有效问卷1059份。1059例CKD住院患者中,207例(19.5%)有营养风险。多因素logistic回归分析显示,CKD分期[比值比(odds ratio,OR)=1.874,95%置信区间(confidence interval,CI)(1.631,2.152),P<0.001]、年龄[OR=1.015,95%CI(1.003,1.028),P=0.018]、华西心晴指数[OR=1.024,95%CI(1.002,1.048),P=0.033]是CKD住院患者营养不良的独立危险因素,血清白蛋白[OR=0.880,95%CI(0.854,0.907),P<0.001]是CKD住院患者营养不良的独立保护因素。多因素logistic回归分析预测模型检验示:一致性指数为0.977,标准差为0.021,P<0.05;曲线下面积为0.977。结论CKD住院患者存在较高的营养不良比例,CKD分期、年龄、心理状况、血清白蛋白是CKD住院患者营养不良的影响因素,基于上述指标构建的多因素logistic回归分析模型具有较好的预测效果,有望为存在营养不良的中国CKD患者实施早期营养干预进而改善其临床结局和生活质量提供助力。

Objective To investigate the nutritional status of hospitalized patients with chronic kidney disease(CKD),analyze the influencing factors,and construct a predictive model to provide a localized theoretical basis and more convenient risk prediction indicators and models for clinical nutrition support and intervention treatment of CKD patients in China.Methods Convenience sampling was used to select hospitalized CKD patients from Department of Nephrology,West China Hospital,Sichuan University,from January to October 2019.General information questionnaires,the Nutritional Risk Screening 2002 scale,and the Huaxi Emotional-distress Index questionnaire were used for data collection.Single factor analyses and multiple logistic regression analysis were conducted to explore the risk factors for malnutrition in CKD hospitalized patients.A predictive model was established and evaluated using receiver operating characteristic(ROC)curve analysis and bootstrap resampling.Results A total of 1059 valid copies of questionnaires were collected out of 1118 distributed.Among the 1059 CKD hospitalized patients,207 cases(19.5%)were identified as having nutritional risk.The multiple logistic regression analysis showed that CKD stage[odds ratio(OR)=1.874,95%confidence interval(CI)(1.631,2.152),P<0.001],age[OR=1.015,95%CI(1.003,1.028),P=0.018],and the Huaxi Emotional-distress Index[OR=1.024,95%CI(1.002,1.048),P=0.033]were independent risk factors for malnutrition in CKD hospitalized patients,while serum albumin[OR=0.880,95%CI(0.854,0.907),P<0.001]was an independent protective factor.The evaluation of the multiple logistic regression analysis predictive model showed a concordance index of 0.977,standard deviation of 0.021,and P<0.05.The area under the ROC curve was 0.977.Conclusions The prevalence of malnutrition is relatively high among CKD hospitalized patients.CKD stage,age,psychological status,and serum albumin are influencing factors for malnutrition in CKD hospitalized patients.The multiple logistic regression model based on the above indicators demonstrates good predictive performance and is expected to provide assistance for early nutritional intervention to improve the clinical outcomes and quality of life for CKD patients with malnutrition in China.