中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (01): 13-17.doi: 10.3969/j.issn.1671-4091.2025.01.002

• 临床研究 • 上一篇    下一篇

基于列线图构建儿童连续性肾脏替代治疗体外循环衰竭预测模型

全梓林    尹 燕    崔冬梅    赵立艳    王方圆    王 娟    何文静    胡宇航     陈 诚    梁绮祯   宋 利   

  1. 510080 广州，1南方医科大学附属广东省人民医院(广东省医学科学院)肾内科血液净化中心
  • 收稿日期:2024-04-07 修回日期:2024-10-31 出版日期:2025-01-12 发布日期:2025-01-12
  • 通讯作者: 宋利 E-mail:songli@gdph.org.cn
  • 基金资助:
    广州市科技计划项目;广东省医学科学技术研究基金项目

Development of a nomogram-based risk  prediction model for extracorporeal circulation failure children on continuous renal replacement therapy#br#

QUAN Zi-lin, YIN Yan, CUI Dong-mei, ZHAO Li-yan, WANG Fang-yuan, WANG Juan, HE Wen-jing, HU Yu-hang, CHEN Cheng, LIANG Qi-zhen, SONG LI   

  1. The Department of Nephrology, the Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
  • Received:2024-04-07 Revised:2024-10-31 Online:2025-01-12 Published:2025-01-12
  • Contact: 510080 广州，1南方医科大学附属广东省人民医院(广东省医学科学院)肾内科血液净化中心 E-mail:songli@gdph.org.cn

PDF

2

摘要： 目的  本研究旨在探讨儿童连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)过程中发生体外循环衰竭的影响因素，并构建预测模型。 方法 回顾性分析2014─2021年在广东省人民医院接受CRRT的370例儿童患者数据，根据CRRT 24小时内是否发生体外循环衰竭分为衰竭组和非衰竭组。通过Lasso回归和临床判断筛选出与体外循环衰竭相关的主要变量，并采用多因素Logistic回归构建预测模型。 结果 最终基于体质量(OR=0.932，95% CI：0.910～0.954，P＜0.001)、平均超滤速度(OR=1.012，95% CI：1.007～1.017，P＜0.001)、血流量不足(OR=26.535，95% CI：12.507～56.297，P＜0.001)和乳酸(OR=1.095，95% CI：1.014～1.183，P=0.021)构建的预测模型，受试者工作特征曲线下面积为0.891。校准曲线和临床决策曲线显示模型具有良好的预测能力和临床获益。 结论 体质量低、平均超滤速度快、血流量不足和乳酸高是儿童CRRT 24小时体外循环衰竭的独立危险因素，此构建的预测模型具有较好的预测效能。

关键词: 儿童, 连续性肾脏替代治疗, 体外循环衰竭, 预测模型

Abstract: Objective  This study aimed to investigate the factors influencing extracorporeal circulation failure during continuous renal replacement therapy (CRRT) in pediatric patients and to develop and validate a predictive model.  Methods  A retrospective analysis was conducted on data from 370 pediatric patients who received CRRT at Guangdong Provincial People's Hospital between 2014 and 2021. Patients were divided into failure and non-failure groups based on the occurrence of extracorporeal circulation failure within 24 hours of CRRT initiation. Through the application of the Lasso regression regularization method and clinical judgement, the key variables associated with extracorporeal circulatory failure were identified and selected. These variables were then incorporated into a multivariate logistic regression analysis to identify independent risk factors, leading to the construction of a predictive model.  Results  The final predictive model was based on body weight (OR=0.932, 95% CI: 0.910～0.954, P＜0.001), mean ultrafiltration rate (OR=1.012, 95% CI: 1.007～1.017, P＜0.001), insufficient blood flow (OR=26.535, 95% CI: 12.507～56.297, P＜0.001), and lactate levels (OR=1.095, 95% CI: 1.014～1.183, P=0.021). The area under the receiver operating characteristic (ROC) curve for the model was 0.891 (85.61%～92.48%). Calibration curves and clinical decision curves indicated that the model has good predictive capability and clinical utility.  Conclusion  Low body weight, high mean ultrafiltration rate, insufficient blood flow, and elevated lactate levels are independent risk factors for extracorporeal circulation failure within 24 hours of CRRT in pediatric patients. The predictive model based on these factors demonstrates high predictive accuracy.

Key words: Pediatrics, Continuous renal replacement therapy, Extracorporeal circulation obstruction, Predictive model

中图分类号: