摘要
目的构建个体化预测肝硬化患者发生隐匿性肝性脑病(CHE)风险的Nomogram预测模型。方法选取2020年1月至2022年12月收治的325例肝硬化患者作为研究对象,采用整群随机分组法将患者分为训练集(n=213)和验证集(n=112),使用单因素和多因素logistic回归分析训练集肝硬化患者发生CHE的危险因素,并建立相关Nomogram预测模型。结果肝性脑病史、合并感染、消化道出血、腹水较重、凝血酶原时间≥16 s、总胆红素水平较高和血氨较高是肝硬化患者发生CHE的独立危险因素(P<0.05)。Nomogram模型验证结果:在0~96%的范围内,模型净获益,训练集和验证集的一致性指数分别为0.830(95%CI:0.802~0.858)和0.807(95%CI:0.877~0.837),两集的校准曲线均趋近于理想曲线,两集的受试者操作特征曲线下面积分别为0.827(95%CI:0.796~0.858)和0.811(95%CI:0.787~0.836)。结论肝硬化患者发生CHE的危险因素较多,基于危险因素构建的Nomogram模型对肝硬化患者CHE的发生风险具有良好的预测价值。
Objective To construct an individualized nomogram prediction model for predicting the risk of the occurrence of covert hepatic encephalopathy(CHE)in patients with liver cirrhosis.Methods 325 cases of liver cirrhosis admitted from January 2020 to December 2022 were selected as the study subjects.Patients were divided into training(n=213)and validation(n=112)sets using a cluster randomization method.The risk factors for CHE occurrence in patients with cirrhosis in the training set were analyzed by univariate and multivariate logistic regression.A prediction model related to the nomogram was established.Results Independent risk factors for the occurrence of CHE in patients with cirrhosis were a history of hepatic encephalopathy,co-infection,gastrointestinal bleeding,severe ascites,prothrombin time≥16 seconds,high total bilirubin,and high blood ammonia levels(P<0.05).Nomogram model validation results:The model had a net benefit for the training and validation sets,with C-indices of 0.830(95%CI:0.802-0.858)and 0.807(95%CI:0.877-0.837),respectively,within the range of 0-96%.The calibration curves of both sets were evenly close to the ideal curves.The AUCs for the ROC curves in both sets were 0.827(95%CI:0.796-0.858)and 0.811(95%CI:0.787-0.836),respectively.Conclusion Patients with cirrhosis have many risk factors for CHE occurrence.The nomogram model constructed based on these risk factors possesses a good predictive value for assessing CHE occurrence in cirrhotic patients.
作者
李晓琴
李阳
倪月琴
曹雯
殷甜甜
陆蕊
Li Xiaoqin;Li Yang;Ni Yueqin;Cao Wen;Yin Tiantian;Lu Rui(Taizhou People's Hospital Affiliated to Nanjing Medical University,Taizhou 225300,China)
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2024年第9期828-834,共7页
Chinese Journal of Hepatology
基金
国家自然科学基金(82372746)。
作者简介
通信作者:李阳,Email:liyang_923@163.com。
