Guo Tianhao, Ma Tao, Gao Ruijiao, Yu Kunlun, Bai Jiangbo
Department of Hand Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.
Department of Trauma Emergency Surgery,The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, 075000, People's Republic of China.
Ther Clin Risk Manag. 2024 Dec 27;20:929-937. doi: 10.2147/TCRM.S498528. eCollection 2024.
A Retrospective study.
Digital necrosis (DN) after replantation can cause some serious complication. Few articles focused on the risk factors of DN; therefore, we aim to investigate the risk factors of necrosis after multiple digital replantation.
We collected the data of patients receiving multiple digital replantation in our hospital between Jan. 2017 and Jan. 2024. Based on the necrosis or not after replantation, patients with DN were as necrosis group (NG), and patients without DN were as success group (SG). The demographics, comorbidities, and admission laboratory examinations of patients were computed by univariate analysis, logistic regression analysis, and receiver operating characteristic (ROC) curve analysis. We then construct a nomogram prediction model, plot ROC curves, calibration curves, and DCA decision curves using R language software.
The survival rate in our study was 83.7% (278 of 332). Univariate analysis indicated that there were significant differences in the level of D-dimer, white blood cell, neutrophil, monocyte, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, system inflammation response index, C-reactive protein (CRP), neutrophils/high density lipoprotein (HDL), monocytes/HDL were significantly higher in NG than in SG. However, logistic regression analysis showed that D-dimer and CRP were independent risk factors of DN, and we identified their cut-off values. Then, we constructed a nomogram prediction model with 0.7538 in AUC of the prediction model with good consistency in the correction curve and good clinical practicality by decision curve analysis.
The level of D-dimer and CRP was found to be closely related to DN. We constructed a nomogram prediction model that can effectively predict DN in patients with multiple digital replantation.
一项回顾性研究。
再植术后手指坏死（DN）可导致一些严重并发症。很少有文章关注DN的危险因素；因此，我们旨在研究多指再植术后坏死的危险因素。
收集2017年1月至2024年1月在我院接受多指再植患者的数据。根据再植后是否发生坏死，将发生DN的患者作为坏死组（NG），未发生DN的患者作为成功组（SG）。通过单因素分析、逻辑回归分析和受试者工作特征（ROC）曲线分析计算患者的人口统计学、合并症和入院实验室检查结果。然后，我们使用R语言软件构建列线图预测模型，绘制ROC曲线、校准曲线和DCA决策曲线。
本研究的存活率为83.7%（332例中的278例）。单因素分析表明，NG组的D-二聚体、白细胞、中性粒细胞、单核细胞、单核细胞与淋巴细胞比值、全身免疫炎症指数、系统炎症反应指数、C反应蛋白（CRP）、中性粒细胞/高密度脂蛋白（HDL）、单核细胞/HDL水平均显著高于SG组。然而，逻辑回归分析显示，D-二聚体和CRP是DN的独立危险因素，并确定了它们的临界值。然后，我们构建了一个列线图预测模型，该模型预测模型的AUC为0.7538，校正曲线一致性良好，决策曲线分析显示具有良好的临床实用性。
发现D-二聚体和CRP水平与DN密切相关。我们构建了一个列线图预测模型，可有效预测多指再植患者的DN。
