维持性血液透析患者衰弱风险预测模型的建立与验证

    Development and validation of risk forecasting model for frailty among maintenance hemodialysis patients

    • 摘要:
      目的  建立维持性血液透析(maintenance hemodialysis,MHD)患者发生衰弱风险的预测模型,并验证预测模型的有效性。
      方法  回顾性选取2023年3月1日至2023年3月31日在潍坊市益都中心医院进行规律血液透析治疗的200例患者,收集患者的一般资料,采用Fried表型进行衰弱评分,将患者分为衰弱组(≥3分)与非衰弱组(<3分)。PHQ-9抑郁症筛查量表进行抑郁评分,GAD-7广泛性焦虑量表进行焦虑评分。运用R语言将入组患者按7∶3的比例随机分为训练集(n = 140)与验证集(n = 60)。基于训练集利用单因素和多因素Logistic回归分析筛选出发生衰弱的独立影响因素,基于赤池信息准则最小值选取最终预测因素并以此构建列线图,基于验证组验证模型的预测效能。
      结果  MHD患者衰弱的发生率为43.5%,年龄、抑郁、活动水平、共病数量是衰弱发生的独立影响因素;利用上述因素构建预测MHD患者衰弱发生风险的列线图模型,模型的受试者工作特征曲线下面积为0.880,灵敏度为82.5%,特异度为81.7%,且校正曲线与理想曲线拟合良好。
      结论  本研究构建的模型对MHD患者衰弱的发生概率具有较好的预测能力,有助于早期识别高风险人群,制定临床干预措施。

       

      Abstract:
      Objective  To establish a prediction model for frailty risk in maintenance hemodialysis (MHD ) patients and verify its effectiveness.
      Methods  A retrospective survey was conducted retrospectively for 200 patients undergoing regular hemodialysis treatment at Yidu Central Municipal Hospital. General data were collected and Fried phenotype was utilized for frailty scores. They were assigned into two groups of frailty (≥3 points) and non-frail (<3 points). Patient health questionnaire-9 (PHQ-9) scale was employed for depression scoring and GAD-7 (generalized anxiety disorder-7) scale for anxiety scoring. They were randomized into training set (n=140) and validation set (n=60) in a 7∶3 ratio using R software. Based upon training group, univariate and multivariate logistic regression analysis was performed for screening for independent influencing factors of weakness and the final predictors were selected based on the minimum value of Akaike Information Criterion (AIC). A nomogram was constructed for verifying the predictive performance of model based upon validation group.
      Results  The incidence of frailty in MHD patients was 43.5%. Age, depression, activity level and number of comorbidities were independent influencing factors of the occurrence of frailty. A nomogram model was constructed for predicting the risk of frailty in MHD patients. Area under the ROC curve of the model was 0.880 with a sensitivity of 82.5% and a specificity of 81.7%. And the correction curve fitted well with the ideal curve.
      Conclusions  The above model offers an excellent predictive capability for the occurring probability of frailty in MHD patients. It is helpful for an early identification of high-risk groups and a proper formulation of clinical interventions.

       

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