摘要
目的通过分析老年重症脑卒中患者营养不良的危险因素,构建相应的列线图模型。方法选取重庆医科大学附属第一医院神经内科重症监护室的老年重症脑卒中患者782例作为研究对象,将其分为建模组547例和验证组235例。根据血清白蛋白水平,将患者分为营养不良组、无营养不良组。通过logistic回归分析确认营养不良发生的影响因素,并构建营养不良风险列线图预测模型。应用Bootstrap法对模型的预测效果进行内部验证,利用验证组数据对模型进行外部验证。结果两组年龄、慢性阻塞性肺疾病史、贫血、查尔森合并症指数(CCI)、格拉斯哥昏迷评分(GCS)、巴氏指数、营养支持方式、机械通气、中性粒细胞计数、红细胞压积、纤维蛋白原、白蛋白、总蛋白比例比较,差异有统计学意义(P<0.05)。logistic回归分析显示,年龄、CCI、GCS评分、贫血、中性粒细胞计数、总蛋白水平、营养支持方式为老年重症脑卒中患者营养不良的独立影响因素(OR>1,P<0.05)。构建模型的ROC曲线下面积为0.858,内部验证结果显示,C-index为0.851;验证组ROC曲线下面积为0.848。结论本研究构建的列线图模型预测效能较好,可为临床早期预测老年重症脑卒中患者营养不良发生风险提供参考。
Objective To analyze the risk factors of malnutrition in senile patients with severe stroke,and to constructed the corresponding column graph model.Methods A total of 782 elderly patients with severe stroke in the intensive care Unit of Department of Neurology of the First Affiliated Hospital of Chongqing Medical University were selected as the research objects and divided into modeling group(547 cases)and validation group(235 cases).According to serum albumin level,patients were divided into malnutrition group and non-malnutrition group.The influencing factors of malnutrition were identified by logistic regression analysis,and the prediction model of malnutrition risk line graph was constructed.The prediction effect of the model was verified internally by Bootstrap method,and the model was verified externally by verification group data.Results There were statistically significant differences in age,history of chronic obstructive pulmonary disease,anemia,Charlson comorbidity index(CCI),Glasgow coma score(GCS),Barthel index,nutritional support,mechanical ventilation,neutrophil count,hematopoietic volume,proportion of fibrinogen,albumin,and total protein between the two groups(P<0.05).Logistic regression analysis showed that age,CCI,GCS score,anemia,neutrophil count,total protein level,and nutritional support were independent influencing factors for malnutrition in senile patients with severe stroke(OR>1,P<0.05).The area under ROC curve of the constructed model was 0.858,and the internal verification results showed that the C-index was 0.851.The area under ROC curve of the verification group was 0.848.Conclusion The prediction effect of the column graph model constructed in this study is good,and it can provide reference for early clinical prediction of malnutrition risk in elderly patients with severe stroke.
作者
李君卓
杨雯
刘光维
张瑞昕
阳佳家
LI Junzhuo;YANG Wen;LIU Guangwei;ZHANG Ruixin;YANG Jiajia(Department of Neurology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
出处
《中国医药导报》
CAS
2023年第5期28-32,共5页
China Medical Herald
基金
重庆市科卫联合医学科研项目(2021MSXM045)。
