CT增强扫描使用碘帕醇致肾损害列线图预测模型构建和验证

Construction and verification of prediction model of Iopamidol-induced renal damage in enhanced CT scan

目的探讨碘帕醇致肾损害相关危险因素,为合理使用碘帕醇提供依据。方法选取2022年1月至2023年6月在我院住院期间行CT增强扫描使用碘帕醇的患者136例,随机分为训练集96例和验证集40例,先用Logistic回归单因素分析,再用Logistic回归多因素分析,构建列线图预测模型,以ROC曲线、校准曲线及临床决策曲线评价模型效能。结果Logistic回归单因素分析显示,吸烟史、脉搏、饮酒史和活化部分凝血活酶时间差异有统计学意义(P<0.05),Logistic回归多因素分析显示,脉搏、吸烟史和活化部分凝血活酶时间是碘帕醇致肾损害独立危险因素(P<0.05);训练集和验证集的列线图模型ROC的AUC分别为0.726和0.779,差异无统计学意义(P>0.05);训练集和验证集的校准曲线拟合优度检验结果差异均无统计学意义(P>0.05);训练集模型临床决策曲线的概率阈值为0.16~0.72时,患者的净受益率>0。结论当患者无吸烟史、脉搏越快及活化部分凝血活酶时间越低时,使用碘帕醇致肾损害的风险显著增加,应采取相关措施。

Objective To construct and verificate a prediction model to explore the related risk factors for Iopamidol-induced blood coagulation and renal damage,aiming to provide a basis for rational use of iopatol.Methods A total of 136 patients who received enhanced CT scan for Iopamidol-induced renal damage in our hospital from January 2022 to June 2023 were randomized to a training set(n=96)or a validation set(n=40).Univariate and multivariate Logistic regression analyses were successively used to construct a prediction nomogram model.The receiver operating characteristic(ROC)curve,calibration curve and decision curve were conducted to evaluate the efficacy of the model.Results Univariate Logistic regression analysis showed that smoking history,faster pulse,drinking history and lower activated partial thromboplastin time had statistically significant differences(P<0.05).Multivariate logistic regression analysis verified that faster pulse,smoking history and lower activated partial thromboplastin time were independent risk factors for Iopatol-induced blood coagulation and kidney damage(P<0.05).The AUC of the nomogram model of the training set and validation set was 0.726 and 0.779,respectively,with no statistical significance(P>0.05).There was no significant difference in the results of goodness of fit test between sets(P>0.05).When the threshold probability of decision curve of training set model was 0.16-0.72,the net benefit rate of patients was>0.Conclusion When patients have no smoking history,faster pulse and lower partial thromboplastin activation time,the risk of Iopamidol-induced renal damage is significantly increased,and relevant measures should be taken.