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肝硬化患者输血风险的预测

Prediction of risk of blood transfusion in patients with cirrhosis.

作者信息

Li Ying, Zhu Wenwen, Song Zhiqun, Liang Wenbiao, Zhou Xiaoyu

机构信息

Blood Transfusion Centre, The First Affiliated Hospital of Nanjing Medical University.

Blood Transfusion Laboratory, Jiangsu Blood Center, Nanjing, China.

出版信息

Eur J Gastroenterol Hepatol. 2025 Apr 1;37(4):477-482. doi: 10.1097/MEG.0000000000002904. Epub 2025 Jan 28.

Abstract

BACKGROUND

Blood transfusion is usually required for cirrhotic patients with bleeding which is related to high risk of mortality. Identifying cirrhotic patients at high risk of bleeding and needing blood transfusions would benefit these patients, yet this remains an unmet need.

OBJECTIVES

This study aims to enhance blood transfusion management for patients with cirrhosis by developing a predictive model to assess the risk of transfusion.

METHODS

We enrolled a cohort of 711 patients diagnosed with cirrhosis at The First Affiliated Hospital of Nanjing Medical University and divided into training set ( n  = 537) and validation set ( n  = 174). Each participant underwent a comprehensive clinical assessment. Data on prothrombin time (PT), platelet counts, and inflammatory markers were collected. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. The nomogram was constructed. Model performance was evaluated through receiver operating characteristic curve analysis.

RESULTS

The study successfully identified PT, platelet counts, and the mentioned inflammatory markers as significant predictors of the need for transfusion. The resulting nomogram demonstrated high predictive accuracy, with area under the curve values of 0.85 in the training set and 0.83 in the validation set.

CONCLUSION

The developed nomogram for predicting the need for blood transfusion in patients with cirrhosis shows promising effectiveness for clinical application. This tool can significantly contribute to optimizing transfusion practices, potentially improving patient care and outcomes through more personalized and efficient transfusion strategies.

摘要

背景

肝硬化出血患者通常需要输血,这与高死亡率风险相关。识别出血风险高且需要输血的肝硬化患者将使这些患者受益,但这一需求仍未得到满足。

目的

本研究旨在通过开发一种预测模型来评估输血风险,以加强肝硬化患者的输血管理。

方法

我们纳入了南京医科大学第一附属医院诊断为肝硬化的711例患者队列,并分为训练集(n = 537)和验证集(n = 174)。每位参与者都接受了全面的临床评估。收集了凝血酶原时间(PT)、血小板计数和炎症标志物的数据。进行单因素和多因素逻辑回归分析以确定独立预测因素。构建了列线图。通过受试者工作特征曲线分析评估模型性能。

结果

该研究成功将PT、血小板计数和上述炎症标志物确定为输血需求的重要预测因素。所得列线图显示出较高的预测准确性,训练集曲线下面积值为0.85,验证集为0.83。

结论

所开发的用于预测肝硬化患者输血需求的列线图在临床应用中显示出有前景的有效性。该工具可显著有助于优化输血实践,通过更个性化和高效的输血策略潜在地改善患者护理和结局。

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