主动脉夹层患者围术期发生焦虑抑郁的风险预测列线图模型构建

Construction of Nomogram Model for Risk Prediction of Anxiety and Depression in Patients with Aortic Dissection during Perioperative Period

目的构建主动脉夹层(AD)患者围术期发生焦虑抑郁的风险预测列线图模型。方法选取2021年2月—2024年2月南京医科大学第一附属医院收治的AD患者338例为研究对象。按照7∶3的比例将患者分为AD建模组(237例)及AD验证组(101例)。收集患者临床资料,依据AD建模组患者围术期焦虑抑郁发生情况将其分为焦虑抑郁亚组(138例)及非焦虑抑郁亚组(99例)。AD患者围术期发生焦虑抑郁的影响因素分析采用多因素Logistic回归分析;基于多因素Logistic回归分析结果,采用R 4.1.3软件构建AD患者围术期发生焦虑抑郁的风险预测列线图模型;采用受试者工作特征(ROC)曲线评估该列线图模型的区分度,采用Hosmer-Lemeshow拟合优度检验评估该列线图模型的拟合情况。结果焦虑抑郁亚组缴费方式为自费者占比高于非焦虑抑郁亚组,发病时向他人求助者占比、能合理处理压力者占比、积极乐观面对生活者占比、能转移负面情绪者占比、发病时向他人倾诉者占比低于非焦虑抑郁亚组(P<0.05)。多因素Logistic回归分析结果显示,缴费方式为自费、发病时不向他人求助、不能合理处理压力、不能积极乐观面对生活、不能转移负面情绪、发病时不向他人倾诉是AD患者围术期发生焦虑抑郁的独立危险因素(P<0.05)。基于多因素Logistic回归分析结果构建AD患者围术期发生焦虑抑郁的风险预测列线图模型。ROC曲线分析结果显示,该列线图模型预测AD建模组、AD验证组患者围术期发生焦虑抑郁的AUC分别为0.926[95%CI(0.885~0.956)]、0.919[95%CI(0.877~0.950)]。Hosmer-Lemeshow拟合优度检验结果显示,该列线图模型在AD建模组、AD验证组中拟合程度较好(χ^(2)值分别为6.469、6.875,P值分别为0.595、0.553)。结论缴费方式为自费、发病时不向他人求助、不能合理处理压力、不能积极乐观面对生活、不能转移负面情绪、发病时不向他人倾诉是AD患者围术期发生焦虑抑郁的独立危险因素,本研究基于上述6个影响因素构建的AD患者围术期发生焦虑抑郁的风险预测列线图模型具有较好的区分度及拟合程度。

Objective To construct the nomogram model for risk prediction of anxiety and depression in patients with aortic dissection(AD)during perioperative period.Methods A total of 338 AD patients admitted to the First Affiliated Hospital with Nanjing Medical University from February 2021 to February 2024 were selected as the study objects.The patients were divided into AD modeling group(237 cases)and AD validation group(101 cases)according to a ratio of 7∶3.The clinical data of the patients were collected,and the AD modeling group was divided into anxiety and depression subgroup(138 cases)and non-anxiety and depression subgroup(99 cases)according to the occurrence of anxiety and depression during perioperative period.The influencing factors of anxiety and depression in AD patients during perioperative period were analyzed by multivariate Logistic regression analysis.Based on the results of multivariate Logistic regression analysis,R 4.1.3 software was used to construct the nomogram model for risk prediction of anxiety and depression in patients with AD during perioperative period.Receiver operating characteristic(ROC)curve was used to evaluate the differentiation of the nomogram model,and Hosmer-Lemeshow goodness of fit test was used to evaluate the fit of the nomogram model.Results The proportion of self-paying patients in the anxiety and depression subgroup was higher than that in the non-anxiety and depression subgroup,the proportion of those who sought help from others,those who could reasonably deal with pressure,those who were positive and optimistic about life,those who could transfer negative emotions,and those who talked to others during the onset was lower than that in the non-anxiety and depression subgroup(P<0.05).The results of multivariate Logistic regression analysis showed that the independent risk factors for anxiety and depression in patients with AD during perioperative period were self-payment,not seeking help from others during onset,failing to deal with pressure reasonably,not facing life positively,failing to transfer negative emotions,and not confide in others during onset(P<0.05).Based on the results of multivariate Logistic regression analysis,the nomogram model for risk prediction of anxiety and depression in patients with AD was constructed.ROC curve analysis results showed that the AUC of the nomogram model in predicting anxiety and depression in patients with AD during perioperative period in AD modeling group and AD verification group was 0.926[95%CI(0.885-0.956)]and 0.919[95%CI(0.877-0.950)],respectively.Hosmer-Lemeshow goodness of fit test showed that the nomogram model fit well in AD modeling group and AD verification group(χ^(2) values were 6.469 and 6.875,Pvalues were 0.595 and 0.553,respectively).Conclusion The independent risk factors for anxiety and depression in patients with AD during perioperative period are self-payment,not seeking help from others during onset,failing to deal with pressure reasonably,not facing life positively,failing to transfer negative emotions,and not confide in others during onset.In this study,the nomogram model for the risk prediction of anxiety and depression in AD patients during perioperative period constructed based on the above 6 influencing factors has a good degree of differentiation and fitting.