[1]王贝贝,崔振义,王静,等.老年股骨粗隆间骨折患者术后贫血预测模型的构建与验证[J].中华老年骨科与康复电子杂志,2024,(06):355-362.[doi:10.3877/cma.j.issn.2096-0263.2024.06.006]
　Wang Beibei,Cui Zhenyi,Wang Jing,et al.Development and Validation of postoperative anemia prediction model in elderly patients with intertrochanteric fracture[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2024,(06):355-362.[doi:10.3877/cma.j.issn.2096-0263.2024.06.006]
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老年股骨粗隆间骨折患者术后贫血预测模型的构建与验证()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2024年06期
页码:
355-362
栏目:
髋部骨折
出版日期:
2024-12-05

文章信息/Info

Title:
Development and Validation of postoperative anemia prediction model in elderly patients with intertrochanteric fracture
作者:
王贝贝1; 崔振义2; 王静1; 王晗妍1; 吕红芝3; 李秀婷4
050051 石家庄，河北医科大学第三医院静脉用药调配中心1，第二手术室2，河北省骨科研究所3，创伤急救中心四病区4
Author(s):
Wang Beibei1;  Cui Zhenyi1;  2;  Wang Jing1;  Wang Hanyan1;  Li Xiuting3.
1Department of Pharmacy Intravenous Admixture Services, 2Department of Second Operating room, 3Orthopaedic Institution of Hebei Province, 4Trauma Emergency Center Ward Four, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
关键词:
老年人;  股骨粗隆间骨折;  贫血;  影响因素;  预测模型
Keywords:
Senile;  Intertrochanteric fracture;  Anemia;  Influencing factors;  Predictive models
DOI:
10.3877/cma.j.issn.2096-0263.2024.06.006
文献标志码:
A
摘要:
目的 分析老年股骨粗隆间骨折患者术后贫血的影响因素并构建预测模型，探究该模型的预测价值。方法 采用回顾性研究，收集2020年1月至2021年12月在河北医科大学第三医院骨科就诊的451例老年股骨粗隆间骨折患者临床资料及化验指标与检查结果，按7∶3比例随机分配到建模集（319例）、验证集（132例）。对建模集资料进行单因素和多因素logistic回归分析筛选出老年股骨粗隆间骨折患者术后贫血的影响因素，并构建列线图预测模型。模型的表现和临床实用性分别用受试者工作特征（ROC）曲线、校准曲线、决策曲线进行评估，同时引入验证集数据对模型进行内部验证。结果 建模集319例老年粗隆间骨折患者中出现贫血为105例（32.90%）。单因素结果显示性别（OR=0.555，95% CI：0.318，0.970）、住院天数（OR=1.104，95% CI：1.040，1.173）、美国麻醉医师协会（ASA）分级评分（OR=0.649，95% CI：0.478，0.883）、入院血红蛋白（Hb）（OR=1.021，95% CI：1.005，1.036）、入院B型钠尿肽（BNP）（OR=0.996，95% CI：0.993，0.999）、左心射血指数（LVEF）（OR=1.067，95% CI：1.021，1.116）有统计学差异（P＜0.05）。多因素logistic回归分析表明性别（OR=0.498，95% CI：0.272，0.912）、住院天数（OR=1.137，95% CI：1.063，1.216）、入院Hb(OR=1.024，95% CI：1.007，1.041）、入院BNP(OR=0.997，95% CI：0.993，0.999）、LVEF（OR=1.050，95% CI：1.001，1.102）是老年股骨粗隆间患者术后贫血的影响因素（P＜0.05），基于上述因素构建老年粗隆间骨折患者贫血列线图模型，模型预测老年股骨粗隆间骨折患者术后贫血的ROC曲线下面积为0.717（95% CI：0.657，0.776）、训练集模型截断值0.341，灵敏度0.634，特异度0.711，约登指数0.345。当决策曲线中建模集与验证集的阈概率分别为0%～70%与0%～62%时，净获益高于不采取及全部采取干预的极端曲线，表明预测模型具有临床有效性。结论 基于性别、住院天数、入院Hb、入院BNP、LVEF建立的预测模型对老年股骨粗隆间骨折患者贫血风险具有一定的预测价值。
Abstract:
Objective To analyze the influencing factors of postoperative anemia in elderly patient with intertrochanteric fracture and establish a predictive model to explore the predictive value of this model. Methods　A retrospective study was conducted to collect the clinical data, laboratory indicators and examination results of 451 elderly patients with intertrochanteric fractures who were treated in the orthopedics department of a hospital from January 2020 to December 2021, and were randomly assigned to the modeling set(319 cases)and validation set (132 cases)according to a ratio of 7:3. Univariate and multivariate logistic regression analysis was performed to screen out the influencing factors of postoperative anemia in elderly patients with intertrochanteric fracture, and a nomogram prediction model was constructed. The performance and clinical practicability of the model were evaluated by Receiver Operating Characteristic (ROC) curve, calibration curve and decision curve respectively,and validation set data were introduced for internal validation of the model. Results Among 319 elderly patients with intertrochanteric fracture in the modelingset, 105 (32.90%) had anemia. Univariate results showed gender (OR=0.555, 95% CI: 0.318-0.970), length of hospital stay(OR=1.104, 95% CI: 1.040, 1.173), American Society of Anesthesiologists (ASA) grade (OR=0.649, 95% CI: 0.478, 0.883), Hemoglobin (Hb) at admission (OR=1.021, 95% CI: 1.005-1.036), B-type natriuretic peptide (BNP) at admission (OR=0.996, 95% CI: 0.993, 0.999), left ventricular ejection fraction (LVEF)(OR=1.067, 95% CI: 1.021, 1.116) there was a statistical difference (P<0.05). Multivariate logistic regression analysis showed that gender (OR=0.498, 95% CI: 0.272, 0.912), length of stay (OR=1.137, 95% CI: 1.063, 1.216), Hb at Admission (OR=1.024, 95% CI: 1.007, 1.041), BNP at Admission (OR=0.997, 95% CI: 0.993, 0.999), LVEF (OR=1.050, 95% CI: 1.001, 1.102) were the influential factors for postoperative anemia in elderly intertrochanteric patients (P<0.05). Based on these factors,anemia column diagram model in elderly patients with intertrochanteric fractures was constructed.The area under ROC curve of the model for predicting postoperative anemia in elderly patients with intertrochanteric fractures was 0.717(95% CI: 0.657, 0.776),the cut off value of the modeling set model was 0.341, the sensitivity was 0.634, the specificity was 0.711, and the Youden index was 0.345. When the threshold probabilities of modeling set and validation set in the decision curve were 9%-59% and 20%-69% respectively in the decision curve, the net benefit was higher than the extreme curve of no intervention and all intervention, indicating the clinical validity of the prediction model. Conclusions　The prediction model based on gender, length of stay, Hb at admission, BNP at admission, and LVEF has a certain value in predicting the risk of anemia in elderly patients with intertrochanteric fracture.

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备注/Memo

备注/Memo:
基金项目：国家自然科学青年基金项目（82102584）；河北省2024年度省卫生健康委医学科学研究课题计划项目（20242118）；河北省卫生健康委2024年政府资助临床医学优秀人才培养项目（ZF2024075）
更新日期/Last Update: 2025-03-10