摘要
目的分析老年胃癌患者术后谵妄的危险因素,建立列线图预测模型并评估其准确性。方法选择2018年2月—2021年9月在本院行胃癌根治性手术的509例老年患者作为建模组;另将2021年10月—2022年6月本院收治132例老年胃癌患者作为验证组。使用LASSO回归、十折交叉验证法获取建模组患者术后谵妄的相关因素,多因素Logistic回归分析筛选独立危险因素,使用R软件建立列线图预测模型。使用Bootstrap法对建模组进行内部验证;并将验证组进行外部验证。结果建模组中术后谵妄的发生率为14.5%。LASSO、多因素logistic回归分析表明年龄、术前营养风险、手术方式、手术时间、术中出血量是术后谵妄的独立危险因素(P<0.05)。建模组和验证组的ROC曲线下面积分别为0.766(95%CI:0.700-0.831)和0.770(95%CI:0.692-0.848),两组的校准曲线显示预测结果和实际结果基本吻合,决策曲线显示两组临床净收益高。结论本研究构建的老年胃癌患者术后谵妄列线图具有较好的区分度和精准度,有助于临床医师早期识别谵妄的高危患者。
Objective To analyze the risk factors of postoperative delirium in elderly patients with gastric cancer,and establish an nomogram prediction model and evaluate its accuracy.Methods 509 elderly patients who underwent radical surgery due to gastric cancer in our hospital during February 2018 and September 2021 were selected as the modeling group,and another 132 elderly patients with gastric cancer those were admitted to our hospital were selected as the validation group.The LASSO regression and ten-fold cross validation were used to obtain the relevant factors of postoperative delirium in the modeling group.The multiplelogistic regression analysis was used to screen independent risk factors,and R software was used to establish a nomogram prediction model.The Bootstrap method was used for internal verification of the modeling group;The verification group was verified externally.Results The incidence of postoperative delirium in the modeling group was 14.5%.The LASSO and multivariate logistic regression analysis showed that age,preoperative nutrition risk,operation mode,operation time and intraoperative bleeding were independent risk factors for postoperative delirium(P<0.05).The areas under the ROC curve of the modeling group and the validation group were 0.766(95%CI:0.700-0.831)and 0.770(95%CI:0.692-0.848),respectively.The calibration curves of the two groups showed that the predicted results were basically consistent with the actual results,and the decision-making curves showed that the two groups had high clinical net benefits.Conclusions The delirium nomogram constructed in this study for elderly patients with gastric cancer after surgery had good discrimination and accuracy,which was helpful for clinicians to identify high-risk patients with delirium early.
作者
陈晓
林新强
蔡宇平
Chen Xiao;Lin Xinqiang;Cai Yuping(Department of anesthesiology surgery,the affiliated hospital of Putian University,Putian,Fujian 351100,China)
出处
《齐齐哈尔医学院学报》
2023年第5期412-417,共6页
Journal of Qiqihar Medical University
关键词
老年患者
胃癌
术后谵妄
列线图
Elderly patients
Gastric cancer
Postoperative delirium
Nomogram
