急性硬膜下血肿患者围术期继发颅内高压的Cox比例风险预测模型的建立及评价

童凌霄; 秦虎; 闫宝锋

doi:10.7619/jcmp.20240815

急性硬膜下血肿患者围术期继发颅内高压的Cox比例风险预测模型的建立及评价

1.
新疆医科大学第二附属医院神经外科, 新疆乌鲁木齐, 830063
2.
新疆医科大学第一附属医院神经外科, 新疆乌鲁木齐, 830000

基金项目:

自治区重点实验室新疆神经系统疾病研究重点实验室开放课题项目 XJDX1711-2114

详细信息

通讯作者:
闫宝锋, E-mail: 77055753@qq.com

中图分类号: R651.1;R195.1;R619
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出版历程
- 收稿日期: 2024-02-28
- 修回日期: 2024-04-25
- 网络出版日期: 2024-07-19
- 刊出日期: 2024-07-14

Establishment and evaluation of Cox proportional-hazards prediction model for secondary intracranial hypertension in perioperative period in patients with acute subdural hematoma

1.
Neurosurgery Department, the Second Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830063
2.
Neurosurgery Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000

摘要

摘要:
目的
构建急性硬膜下血肿(ASDH)患者围术期继发颅内高压的Cox比例风险预测模型，并对其效能进行验证。
方法
回顾性收集78例ASDH患者的临床资料，按围术期继发颅内高压情况将其分为继发组(25例，围术期继发颅内高压)和对照组(53例，围术期未继发颅内高压)。比较2组患者人口统计学指标、合并症、临床生化指标及影像学资料等因素的差异。应用Cox比例风险模型对ASDH患者围术期继发颅内高压的可能影响因素进行多因素分析。建立ASDH患者围术期继发颅内高压的预测模型并测算Harrell′s C指数以评估模型预测的准确度。通过列线图及校准曲线评估该模型预测风险概率与实际风险概率的符合程度。
结果
全组半年随访率为89.74%(70/78)。继发组年龄、吸烟史、高血压病、糖尿病、术前格拉斯哥昏迷量表(GCS) 评分、格拉斯哥预后量表(GOS) 评分、复合型血肿、颅内血肿体积、平均动脉压、糖化血红蛋白(HbA1c)、国际标准化比值(INR)、白细胞介素-6(IL-6)、降钙素原(PCT) 与对照组比较，差异有统计学意义(P < 0.05)。年龄(OR=2.895, 95%CI: 1.264~6.633, P=0.022)、吸烟史(OR=2.146, 95%CI: 1.029~4.475, P=0.036)、GOS评分(OR=0.288, 95%CI: 0.112~0.741, P=0.015)、HbA1c(OR=3.325, 95%CI: 1.243~8.894, P=0.028)、INR(OR=2.746, 95%CI: 1.203~6.267, P=0.027)、PCT(OR=3.426, 95%CI: 1.335~8.795, P=0.019)是ASDH患者围术期继发颅内高压的独立影响因素, Harrell′s C指数为0.812(95%CI: 0.789~0.872)。列线图及校准曲线显示实际风险与模型预测风险存在较好的一致性。
结论
急性硬膜下血肿患者的Cox比例风险模型预测围术期继发颅内高压风险的准确度高，适宜临床推广。
- 急性硬膜下血肿 /
- 颅内高压 /
- 危险因素 /
- Cox比例风险模型
Abstract:
Objective
To construct a Cox proportional hazards prediction model for secondary intracranial hypertension in patients with acute subdural hematoma (ASDH) during the perioperative period and validate its effectiveness.
Methods
Clinical data of 78 patients with ASDH were retrospectively collected and divided into secondary group (25 cases with secondary intracranial hypertension during perioperation) and control group (53 cases without secondary intracranial hypertension during perioperation). Differences in demographic indicators, comorbidities, clinical biochemical indicators, and imaging data between the two groups were compared. The Cox proportional hazards model was used to perform a multivariate analysis of independent risk factors that may affect secondary intracranial hypertension in ASDH patients during the perioperative period. A prediction model for secondary intracranial hypertension in ASDH patients during the perioperative period was established, and Harrell′s C index was calculated to assess the predictive accuracy of the model. The degree of agreement between the model prediction and actual risks was evaluated through a nomogram and calibration curve.
Results
The six-month follow-up rate was 89.74% (70/78). Age, smoking history, hypertension, diabetes, preoperative Glasgow Coma Scale (GCS) score, Glasgow Outcome Scale (GOS) score, complex hematoma, intracranial hematoma volume, mean arterial pressure, glycated hemoglobin (HbA1c), international normalized ratio (INR), interleukin-6 (IL-6), and procalcitonin (PCT) in the secondary group showed statistically significant differences compared with the control group (P < 0.05). Age(OR=2.895; 95%CI, 1.264 to 6.633; P=0.022), smoking history (OR=2.146; 95%CI, 1.029 to 4.475; P=0.036), GOS score (OR=0.288; 95%CI, 0.112 to 0.741; P=0.015), HbA1c (OR=3.325; 95%CI, 1.243 to 8.894; P=0.028), INR (OR=2.746; 95%CI, 1.203 to 6.267; P=0.027), and PCT (OR=3.426; 95%CI, 1.335 to 8.795; P=0.019) were independent influencing factors for secondary intracranial hypertension in ASDH patients during the perioperative period. Harrell′s C index was 0.812 (95%CI, 0.789 to 0.872). The nomogram and calibration curve showed good consistency between the actual risk and the model prediction.
Conclusion
Cox proportional hazards model for patients with acute subdural hematoma has high accuracy in predicting the risk of secondary intracranial hypertension during the perioperative period and is suitable for clinical promotion.
- acute subdural hematoma /
- intracranial hypertension /
- risk factor /
- Cox proportional hazard model

HTML全文

图 1 ASDH患者围术期继发颅内高压预警模型的列线图

下载: 全尺寸图片幻灯片

图 2 基于Cox比例风险预警模型预测围术期继发颅内高压风险的校准图

下载: 全尺寸图片幻灯片

表 1 影响围术期颅内高压发生的单因素分析(x±s)[n(%)][M(P₂₅, P₇₅)]

因素	继发组(n=25)	对照组(n=53)	χ²/t/Z	P
男	14(56.0)	37(69.8)	1.432	0.231
女	11(44.0)	16(30.2)
年龄/岁	52.8±9.5	60.4±10.3	3.402	0.003
吸烟史	15(60.0)	18(34.0)	4.718	0.030
酗酒史	9(36.0)	14(26.4)	0.751	0.386
脑血管病家族史	8(32.0)	11(20.8)	1.166	0.280
高血压病	16(64.0)	18(34.0)	6.233	0.013
糖尿病	13(52.0)	14(26.4)	4.913	0.027
术前格拉斯哥昏迷量表评分/分	8.5±2.1	11.8±2.4	5.889	< 0.001
格拉斯哥预后量表评分/分	2.5±0.4	3.8±1.1	5.717	< 0.001
复合型血肿	15(60.0)	18(34.0)	4.718	0.030
颅内血肿体积/mm³	35.5±9.6	24.8±7.5	5.364	< 0.001
术前瞳孔散大	7(28.0)	5(9.4)	0.439	0.508
平均动脉压/mmHg	185.2±20.6	172.7±18.4	2.694	0.009
糖化血红蛋白/%	7.5±2.6	5.8±1.9	3.265	0.002
红细胞计数/(×10⁹/L)	3.5(2.7, 4.6)	3.3(2.5, 3.8)	1.389	0.327
血红蛋白/(g/L)	123.5(87.7, 144.0)	117.5(79.8, 138.2)	0.822	0.406
血小板计数/(×10⁹/L)	83.5(56.4, 128.2)	86.2(58.6, 134.3)	0.412	0.515
白细胞计数/(×10⁹/L)	5.5(3.7, 12.9)	6.0(4.8, 13.8)	1.756	0.243
中性粒细胞计数/(×10⁹/L)	3.4(2.3, 6.0)	4.0(2.8, 10.2)	2.342	0.175
淋巴细胞计数/(×10⁹/L)	1.0(0.7, 1.4)	0.8(0.4, 1.2)	0.471	0.489
凝血酶原时间/s	20.2±3.1	19.1±2.6	1.638	0.106
活化部分凝血活酶时间/s	46.2±4.3	44.5±3.7	1.797	0.076
国际标准化比值	2.1(1.5, 2.8)	1.5(1.0, 1.7)	4.289	< 0.001
D-二聚体/(μg/mL)	9.9(5.5, 10.4)	10.5(8.1, 12.4)	0.372	0.613
尿素氮/(mmol/L)	6.2±1.2	5.7±1.6	1.387	0.169
肌酐/(mmol/L)	104.3±15.8	96.8±17.4	1.828	0.071
丙氨酸氨基转移酶/(U/L)	44.5±7.6	41.4±6.8	1.809	0.074
天门冬氨酸氨基转移酶/(U/L)	48.3±6.4	45.8±7.4	1.451	0.151
总蛋白/(g/L)	58.8±4.7	61.0±5.4	1.747	0.084
白蛋白/(g/L)	23.8±2.7	25.1±2.9	1.888	0.063
总胆红素/(μmol/L)	42.8(23.7, 61.2)	50.3(26.6, 71.7)	0.953	0.368
甘油三酯/(mmol/L)	1.25±0.31	1.36±0.24	1.717	0.090
总胆固醇/(mmol/L)	2.83±0.68	2.58±0.74	1.428	0.157
低密度脂蛋白/(mmol/L)	1.75±0.41	1.57±0.39	1.871	0.065
高密度脂蛋白/(mmol/L)	0.95±0.21	1.02±0.34	1.745	0.085
血钾/(mmol/L)	3.8±0.7	4.1±0.8	1.606	0.112
血钠/(mmol/L)	138.5±3.8	140.1±3.5	1.850	0.068
白细胞介素-6/(pg/mL)	365.8(123.5, 690.4)	92.1(34.7, 232.8)	4.724	< 0.001
降钙素原/(ng/mL)	2.9±0.4	1.8±0.2	16.244	< 0.001
C反应蛋白/(mg/L)	17.8(7.5, 33.6)	16.5(6.9, 29.7)	0.480	0.482
1 mmHg=0.133 322 kPa。

下载: 导出CSV

表 2 Cox比例风险模型对围术期颅内高压发生的多因素分析

因素	回归系数	标准误	Wald系数	OR	P	95%CI
年龄	1.063	0.423	6.315	2.895	0.022	1.264~6.633
吸烟史	0.764	0.375	4.146	2.146	0.036	1.029~4.475
术前格拉斯哥昏迷量表评分	0.772	0.468	2.724	2.165	0.069	0.865~5.418
格拉斯哥预后量表评分	-1.244	0.482	6.670	0.288	0.015	0.112~0.741
复合型血肿	0.766	0.556	1.900	2.152	0.105	0.723~6.399
颅内血肿体积	0.686	0.436	2.476	1.986	0.091	0.845~4.663
平均动脉压	0.710	0.521	1.860	2.035	0.101	0.733~5.650
糖化血红蛋白	1.201	0.502	5.728	3.325	0.028	1.243~8.894
国际标准化比值	1.010	0.421	5.757	2.746	0.027	1.203~6.267
白细胞介素-6	0.966	0.540	3.202	2.628	0.061	0.911~7.573
降钙素原	1.230	0.481	6.554	3.426	0.019	1.335~8.795

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