摘要
目的探讨老年脑出血患者发病1个月内死亡的危险因素并构建相应的风险模型。方法选取2019年1月至2022年1月于海安市人民医院就诊的285例老年脑出血住院患者为研究对象,根据患者发病1个月时的生存状态分为死亡组(n=69)和存活组(n=216)。比较2组患者的临床、实验室和影像学检查结果等资料,分析此类患者发病早期死亡的相关危险因素并通过二元Logistic回归分析构建风险模型,通过受试者操作特征(ROC)曲线评估该模型的效能。结果同存活组患者相比较,死亡组患者年龄、入院时美国国立卫生研究院卒中量表(NIHSS)评分、白细胞、糖化血红蛋白(HbA1C)、D‑二聚体、尿酸(UA)、三酰甘油(TG)和脑出血体积显著增加,且出现感染和消化道出血的比例更高,而入院格拉斯哥(Glasgow)评分、血红蛋白、估算的肾小球滤过率(eGFR)和白蛋白水平显著降低(均P<0.05)。入院Glasgow评分、感染、消化道出血、白细胞、血红蛋白、D‑二聚体、eGFR、白蛋白、UA和TG是影响老年脑出血患者1个月内死亡的危险因素。所构建的风险模型鉴别患者发病1个月内是否死亡的曲线下面积(AUC)为0.99,敏感度和特异度分别为98.6%和89.8%。结论入院Glasgow评分、感染、消化道出血、白细胞、血红蛋白、D‑二聚体、eGFR、白蛋白、UA和TG是影响老年脑出血患者短期死亡的危险因素,据此构建的模型对老年脑出血患者1个月内的死亡风险评估有较高的效能。
Objective To explore the risk factors for death within 1 month in the elderly patients with intracranial hemorrhage(ICH)and also to establish a risk‑prediction model.Methods A total of 285 elderly patients with ICH diagnosed and treated in the hospital from January 2019 to January 2022 were recruited as study subjects and were divided into the death group(n=69)and the survival group(n=256),according to the life status at 1 month after the onset of ICH.The clinical,laboratory and imaging data were compared between the patients of the 2 groups.Related risk factors for early and abrupt death of such patients were analyzed and riskprediction model was established by Logistic regression method.The diagnostic efficacy of the established model was evaluated by the receiver‑operating characteristic curve(ROC).Results As compared with those of the patients in the survival group,the age,the scores of National Institute of Health Stroke Scale(NIHSS),white blood cell count,Glycosylated hemoglobin type AIc(HbA1C),Ddimer,uric acid,triglyceride(TG)and hematoma volume in the patients of the death group significantly increased,and the rates of infection and gastrointestinal hemorrhage were even higher.However,the Glasgow scores,hemoglobin level,the estimated glomerular filtration rate(eGFR)and albumin level decreased to a considerable extent(all P<0.05).The Glasgow scores and the levels of infection,gastrointestinal hemorrhage,white blood cell count,hemoglobin,D‑dimer,eGFR,albumin,UA and TG at admission were risk factors for death within 1 month.The area under the curve(AUC),sensitivity and specificity of the model were 0.99,98.6%and 89.8%,respectively.Conclusion The Glasgow scores,levels of infection,gastrointestinal hemorrhage,white blood cell count,hemoglobin,D‑dimer,eGFR,albumin,UA and TG at admission were risk factors affecting the death of the patients within a short time.The established model is of high efficacy for the prediction of death within 1 month in the elderly patients with ICH.
作者
顾仁丽
崔益秋
徐婷
Gu Renli;Cui Yiqiu;Xu Ting(Department of Neurosurgery,Haian People’s Hospital,Nantong 226600,China)
出处
《海军医学杂志》
2023年第8期830-834,共5页
Journal of Navy Medicine
关键词
老年
脑出血
危险因素
模型
Elderly
Intracranial hemorrhage
Risk factor
Model
