摘要
目的分析急诊多发伤病人早期死亡的危险因素,建立并验证列线图预测模型。方法回顾性分析2019年1月至2023年8月联勤保障部队第九〇八医院收治的289例急诊多发伤病人的临床数据,通过单因素及多因素logistic回归分析探讨影响急诊多发伤病人早期死亡的危险因素,并基于上述危险因素,构建列线图预测模型。采用受试者操作特征曲线(ROC曲线)和校准曲线评价该预测模型的区分能力和预测准确性,并通过决策曲线分析(DCA)评估该模型在临床上的适用性。结果多因素logistic回归分析显示,年龄≥43岁、乳酸≥2.3 mmol/L和创伤严重度评分(ISS)≥25分是早期死亡的独立危险因素(均P<0.001);碱剩余>-2.8 mmol/L和格拉斯哥昏迷量表(GCS)评分>7分对早期死亡具有保护作用(均P<0.05);列线图的ROC曲线曲线下面积为0.84[95%CI:(0.76,0.92)];Hosmer-Lemeshow(HL)拟合优度检验显示χ^(2)=3.73,P=0.880;DCA结果显示具有正向净获益,表明列线图对急诊多发伤病人早期死亡具有较好的预测性能。结论该列线图示年龄、乳酸、ISS是急诊多发伤病人早期死亡的危险因素,碱剩余和GCS对早期死亡具有保护作用。
Objective To analyze the risk factors for early death in emergency patients with multiple injuries,and to establish and verify the nomogram prediction model.Methods The clinical data of 289 patients with emergency multiple injuries admitted to The 908th Hospital of the Joint Logistics Support Force from January 2019 to August 2023 were retrospectively analyzed.Univariate and multivariate logistic regression analyses were used to investigate the factors affecting the early death of patients,and based on those risk factors,a nomogram prediction model was constructed.The model's differentiability and predictive performance were evaluated using receiver operating characteristic curves(ROC)and calibration curves,and the model's clinical applicability was evaluated by decision curve analysis(DCA).Results Multivariate logistic regression analysis results showed that age≥43 years old,lactic acid≥2.3 mmol/L and injury severity score(ISS)≥25 points were independent risk factors for early death(all P<0.001).Base excess(BE)>−2.8 mmol/L and Glasgow Coma Score(GCS)>7 were protective against early death(both P<0.05).The area under ROC curve of the nomogram was 0.84[95%CI:(0.76,0.92)],the Hosmer-Lemeshow(HL)goodness-of-fit test was 3.73,P=0.880,and the DCA results showed a positive net benefit,indicating that the nomogram had a good predictive performance for early death in emergency patients with multiple injuries.Conclusion The nomogram shows that age,lactate,and ISS are risk factors for early death in emergency multiple injury patients,while BE and GCS have protective effects on early death.
作者
彭小玲
阮春花
张梦玲
彭烨
陈卓敏
PENG Xiaoling;RUAN Chunhua;ZHANG Mengling;PENG Ye;CHEN Zhuomin(Department of Emergency Medicine,The 908th Hospital of the Joint Logistics Support Force,Nanchang,Jiangxi 330003,China)
出处
《安徽医药》
2025年第6期1138-1142,共5页
Anhui Medical and Pharmaceutical Journal
基金
江西省卫生健康委科技计划项目(20204808)。
