Chen Zhengwei, Wang Gaoxiang, Wu Mingsheng, Wang Yu, Zhang Zekai, Xia Tianyang, Xie Mingran
Wannan Medical College, Wuhu 241001, China.
Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, China.
Zhongguo Fei Ai Za Zhi. 2024 Jan 20;27(1):38-46. doi: 10.3779/j.issn.1009-3419.2024.101.02.
Chronic cough after pulmonary resection is one of the most common complications, which seriously affects the quality of life of patients after surgery. Therefore, the aim of this study is to explore the risk factors of chronic cough after pulmonary resection and construct a prediction model.
The clinical data and postoperative cough of 499 patients who underwent pneumonectomy or pulmonary resection in The First Affiliated Hospital of University of Science and Technology of China from January 2021 to June 2023 were retrospectively analyzed. The patients were randomly divided into training set (n=348) and validation set (n=151) according to the principle of 7:3 randomization. According to whether the patients in the training set had chronic cough after surgery, they were divided into cough group and non-cough group. The Mandarin Chinese version of Leicester cough questionnare (LCQ-MC) was used to assess the severity of cough and its impact on patients' quality of life before and after surgery. The visual analog scale (VAS) and the self-designed numerical rating scale (NRS) were used to evaluate the postoperative chronic cough. Univariate and multivariate Logistic regression analysis were used to analyze the independent risk factors and construct a model. Receiver operator characteristic (ROC) curve was used to evaluate the discrimination of the model, and calibration curve was used to evaluate the consistency of the model. The clinical application value of the model was evaluated by decision curve analysis (DCA).
Multivariate Logistic analysis screened out that preoperative forced expiratory volume in the first second/forced vital capacity (FEV1/FVC), surgical procedure, upper mediastinal lymph node dissection, subcarinal lymph node dissection, and postoperative closed thoracic drainage time were independent risk factors for postoperative chronic cough. Based on the results of multivariate analysis, a Nomogram prediction model was constructed. The area under the ROC curve was 0.954 (95%CI: 0.930-0.978), and the cut-off value corresponding to the maximum Youden index was 0.171, with a sensitivity of 94.7% and a specificity of 86.6%. With a Bootstrap sample of 1000 times, the predicted risk of chronic cough after pulmonary resection by the calibration curve was highly consistent with the actual risk. DCA showed that when the preprobability of the prediction model probability was between 0.1 and 0.9, patients showed a positive net benefit.
Chronic cough after pulmonary resection seriously affects the quality of life of patients. The visual presentation form of the Nomogram is helpful to accurately predict chronic cough after pulmonary resection and provide support for clinical decision-making.
肺切除术后慢性咳嗽是最常见的并发症之一，严重影响患者术后生活质量。因此，本研究旨在探讨肺切除术后慢性咳嗽的危险因素并构建预测模型。
回顾性分析2021年1月至2023年6月在中国科学技术大学附属第一医院接受肺叶切除术或肺切除术的499例患者的临床资料和术后咳嗽情况。根据7:3随机化原则将患者随机分为训练集（n = 348）和验证集（n = 151）。根据训练集中患者术后是否有慢性咳嗽，将其分为咳嗽组和非咳嗽组。采用中文版莱斯特咳嗽问卷（LCQ-MC）评估手术前后咳嗽的严重程度及其对患者生活质量的影响。采用视觉模拟量表（VAS）和自行设计的数字评分量表（NRS）评估术后慢性咳嗽。采用单因素和多因素Logistic回归分析独立危险因素并构建模型。采用受试者工作特征（ROC）曲线评估模型的辨别力，采用校准曲线评估模型的一致性。采用决策曲线分析（DCA）评估模型的临床应用价值。
多因素Logistic分析筛选出术前第一秒用力呼气量/用力肺活量（FEV1/FVC）、手术方式、上纵隔淋巴结清扫、隆突下淋巴结清扫及术后胸腔闭式引流时间是术后慢性咳嗽的独立危险因素。基于多因素分析结果，构建了列线图预测模型。ROC曲线下面积为0.954（95%CI：0.930 - 0.978），最大约登指数对应的截断值为0.171，灵敏度为94.7%，特异度为86.6%。经1000次Bootstrap抽样，校准曲线预测肺切除术后慢性咳嗽的风险与实际风险高度一致。DCA显示，当预测模型概率的先验概率在0.1至0.9之间时，患者显示出正的净效益。
肺切除术后慢性咳嗽严重影响患者生活质量。列线图的直观呈现形式有助于准确预测肺切除术后慢性咳嗽，并为临床决策提供支持。
