个体化预测老年慢性肾衰竭患者并发急性左心衰风险的列线图模型构建

Establishment of nomogram model for individualized prediction of risk of acute left heart failure in elderly patients with chronic renal failure

目的构建个体化预测老年慢性肾衰竭患者并发急性左心衰风险的列线图模型。方法选取2019年1月至12月某医院收治的294例老年慢性肾衰竭患者作为研究对象,根据有无发生急性左心衰分为左心衰组(n=61)和对照组(n=233),收集患者临床资料,采用单因素和多因素logistic回归分析老年慢性肾衰竭患者并发急性左心衰的危险因素,并建立列线图模型。结果年龄≥70岁、糖尿病、血压控制不佳、血磷浓度≥1.61 mmol/L、血红蛋白<60 g/L和肺部感染是老年慢性肾衰竭患者并发急性左心衰的危险因素(P<0.05)。模型验证结果显示C-index为0.745,校准曲线趋近于理想曲线,ROC曲线的AUC为0.751(95%CI:0.711~0.791),决策曲线显示阈值概率为10%~84%时列线图预测风险净获益。结论年龄≥70岁、糖尿病、血压控制不佳、血磷浓度≥1.61 mmol/L、血红蛋白<60 g/L和肺部感染会增加老年慢性肾衰竭患者并发急性左心衰的风险,本研究建立的列线图模型对老年慢性肾衰竭患者并发急性左心衰具有良好的预测效能。

Objective To construct a nomogram model for predicting the risk of acute left heart failure in elderly patients with chronic renal failure.Methods Two hundred and ninety-four elderly patients with chronic renal failure admitted to our hospital from January 2019 to December 2019 were selected as the study subjects.According to the occurrence of acute left heart failure,they were divided into the left heart failure group(n=61)and the control group(n=233).The clinical data of the patients were collected.The risk factors of acute left heart failure in elderly patients with chronic renal failure were analyzed by univariate and multivariate logistic regression,and a nomogram model was established.Results Age≥70 years old,diabetes,poor blood pressure control,blood phosphorus concentration≥1.61 mmol/L,hemoglobin<60g/L and pulmonary infection were independent risk factors of acute left heart failure in elderly patients with chronic renal failure(P<0.05).The model validation results showed that the C-index was 0.745,the calibration curve was close to the ideal curve,and the AUC of the ROC curve was 0.751(95%CI:0.711-0.791).Within the range of 10%-84%,the nomogram had a net benefit.Conclusion Age≥70 years old,diabetes,poor blood pressure control,blood phosphorus concentration≥1.61mmol/L,hemoglobin<60g/L and pulmonary infection will increase the risk of acute left heart failure in elderly patients with chronic renal failure.The nomogram model established in this study has a good predictive effect on acute left heart failure in elderly patients with chronic renal failure.