老年急性胆囊炎患者延迟诊断的危险因素分析和诊断预测

Analysis of the factors influencing delayed diagnosis of elderly patients with acute cholecystitis

目的:探讨影响老年急性胆囊炎延迟诊断的相关因素,以期为临床实践提供参考依据。方法:回顾性分析我院2021年3月—2023年3月收治的诊断为急性胆囊炎的135例老年患者的资料,分为延迟诊断组(>3 d)39例和无延迟诊断组(<3 d)96例。采用Logistic回归模型分析筛选影响老年急性胆囊炎延迟诊断的相关因素,构建列线图预测模型,ROC曲线分析各指标的预测价值。结果:年龄≥80岁(OR=3.279,95%CI:1.117~9.606,P=0.032)、男性(OR=3.031,95%CI:1.233~7.446,P=0.016)、白蛋白水平高(OR=0.291,95%CI:0.120~0.712,P=0.006)、体质量指数高(OR=1.408,95%CI:1.061~1.869,P=0.020)、缺乏腹部疼痛(OR=2.788,95%CI:1.219~6.364,P=0.019)是老年急性胆囊炎患者延迟诊断的独立危险因素。这5项指标联合诊断的ROC曲线下面积为0.98(95%CI:0.96~0.99),灵敏度为92.94%,特异度为91.72%,约登指数为0.85。5项指标联合对预测老年急性胆囊炎延迟诊断的发生具有很好的诊断预测价值。结论:80岁以上、男性、血清白蛋白水平较低、体质量指数较高(BMI>25 kg/m2)及没有腹痛症状的患者更容易出现延迟诊断的情况。临床医生应注意这些指标,以提高准确诊断比例,降低延迟诊断的风险。

Objective To explore the factors that contribute to the delayed diagnosis of acute cholecystitis in the elderly and provide valuable insights for clinical practice.Methods A retrospective analysis was conducted on 135 elderly patients who were diagnosed with acute cholecystitis between March 2021 and March 2023 in our hospital.Based on the time of diagnosis,the patients were divided into two groups:a delayed diagnosis group(diagnosed after 3 days)and an undelayed diagnosis group(diagnosed within 3 days).The study analyzed the factors that influenced the delayed diagnosis of acute cholecystitis in the elderly using a logistic regression model.Additionally,a column line graph prediction model was constructed to predict the delayed diagnosis of acute cholecystitis in the elderly.The ROC curve was used to evaluate the predictive value of each indicator for the delayed diagnosis of acute cholecystitis in the elderly.Results Several factors were associated with delayed diagnosis of acute cholecystitis in the elderly.These factors include age≥80 years(OR=3.279,95%CI:1.117~9.606,P=0.032),male gender(OR=3.031,95%CI:1.233~7.446,P=0.016),serum albumin level(OR=0.291,95%CI:0.120~0.712,P=0.006),body mass index(BMI)(OR=1.408,95%CI:1.061~1.869,P=0.020),and lack of abdominal pain(OR=2.788,95%CI:1.219~6.364,P=0.019).The combined diagnosis of these five indicators had good diagnostic value in predicting the occurrence of delayed diagnosis of acute cholecystitis in the elderly,with an area under the receiver operating characteristic curve(AUC)of 0.98(95%CI:0.96~0.99),sensitivity of 92.94%,specificity of 91.72%,and an odds ratio of 0.85.Conclusion Patients who are 80 years or older,male,have low serum albumin levels,higher BMI(BMI>25 kg/m2),and no abdominal pain are more likely to experience a delayed diagnosis of acute cholecystitis.Clinicians should consider these factors to enhance the accuracy of diagnosis and minimize the risk of delayed diagnosis.