急危重症患者医疗器械相关压力性损伤风险预测模型的构建与验证

Construction and validation of a risk prediction model for device-related pressure injuries in critically ill patients

  • 摘要:
    目的 探讨急危重症患者医疗器械相关压力性损伤(DRPI)的影响因素,构建风险预测模型并验证。
    方法 回顾性分析136例急危重症患者的临床资料,根据是否发生DRPI, 将患者分为发生组32例和未发生组104例。采用单因素分析和二元Logistic回归分析探讨DRPI的影响因素,并构建二元Logistic回归模型。采用Hosmer-Lemeshow检验评估模型的拟合优度,采用受试者工作特征(ROC)曲线的曲线下面积(AUC)评估模型的预测效能,同时采用Bootstrap法对模型进行内部验证。
    结果 单因素分析结果显示, 2组患者在年龄、糖尿病、ICU入住时间、无创通气面罩使用时间、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、Braden量表评分、使用血管活性药物、俯卧位通气、血红蛋白水平、乳酸水平方面比较,差异有统计学意义(P < 0.05); 二元Logistic回归分析结果显示,年龄、糖尿病、ICU入住时间、APACHEⅡ评分、无创通气面罩使用时间、使用血管活性药物、俯卧位通气、乳酸水平、Braden量表评分、血红蛋白水平均为急危重症患者DRPI的独立影响因素(P < 0.05)。基于独立影响因素构建预测急危重症患者DRPI风险的二元Logistic回归模型,该模型的整体预测准确率为99.26%, Hosmer-Lemeshow拟合优度检验结果显示该模型的拟合优度良好(χ2 < 0.001, P>0.999); 通过Bootstrap法进行内部验证, ROC曲线显示该模型预测急危重症患者发生DRPI的AUC为0.952, 敏感度为87.5%, 特异度为93.3%。
    结论 本研究构建的急危重症患者DRPI风险预测模型具有良好的稳定性和预测效能, 有助于临床医护人员筛查高风险患者并制订个性化干预方案。

     

    Abstract:
    Objective To explore the influencing factors of device-related pressure injuries (DRPI) in critically ill patients, construct a risk prediction model, and validate its effectiveness.
    Methods A retrospective analysis was conducted on the clinical data of 136 critically ill patients. Based on the occurrence of DRPIs, the patients were divided into occurrence group (32 patients) and non-occurrence group (104 patients). Univariate analysis and binary Logistic regression analysis were used to investigate the influencing factors of DRPIs, and a binary Logistic regression model was constructed. The Hosmer-Lemeshow test was used to assess the goodness of fit of the model, and the area (AUC) under the receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of the model.Additionally, the Bootstrap method was employed for internal validation of the model.
    Results Univariate analysis revealed statistically significant differences between the two groups in terms of age, diabetes, ICU stay duration, duration of non-invasive ventilation mask use, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, Braden scale score, use of vasoactive drugs, prone position ventilation, hemoglobin levels, and lactate levels (P < 0.05). Binary Logistic regression analysis indicated that age, diabetes, ICU stay duration, APACHE Ⅱ score, duration of non-invasive ventilation mask use, use of vasoactive drugs, prone position ventilation, lactate levels, Braden scale score, and hemoglobin levels were independent influencing factors for DRPIs in critically ill patients (P < 0.05). A binary Logistic regression model for predicting the risk of DRPIs in critically ill patients was constructed based on these independent factors. The overall prediction accuracy of the model was 99.26%. The Hosmer-Lemeshow goodness-of-fit test showed that the model had good fitness (χ2 < 0.001, P>0.999). Internal validation using the Bootstrap method and ROC curve analysis showed that the AUC of the model for predicting DRPIs in critically ill patientswas 0.952, with a sensitivity of 87.5% and a specificity of 93.3%.
    Conclusion The risk prediction model for DRPIs in critically ill patients constructed in this study demonstrates good stability and predictive performance. It can assist clinical healthcare professionals in screening high-risk patients and formulating personalized intervention plans.

     

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