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预测急性敌草快中毒患者死亡风险的列线图模型的构建与验证

Construction and validation of a nomogram model to predict mortality risk in patients with acute diquat poisoning.

作者信息

Jiang Lu, Li Mei, Fang Yinglian, Yang Xue

机构信息

Dermatology Department, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University Chengdu 610041, Sichuan, China.

Outpatient Department, West China Hospital Chengdu 610041, Sichuan, China.

出版信息

Am J Transl Res. 2025 Mar 15;17(3):1901-1909. doi: 10.62347/XXIL7895. eCollection 2025.

Abstract

OBJECTIVE

To analyze the risk factors for mortality in patients with acute diquat (DQ) poisoning and construct a nomogram prediction model for clinical assessment and treatment.

METHODS

A retrospective analysis was performed on the clinical data of 110 patients with acute DQ poisoning who were admitted from March 2022 to April 2024. The enrolled patients were divided into a training set of 80 cases and a validation set of 30 cases. A survival group and a death group were established, with death within 30 days as the endpoint. Among these, in the training group, there were 67 cases in the survival group and 13 cases in the death group. This study further analyzed and compared the baseline and clinical data of the two groups of patients, screened potential risk factors using Least absolute shrinkage and selection operator (LASSO) regression, and determined independent risk factors through multivariate logistic regression analysis. A nomogram predictive model was constructed and validated based on the validation set.

RESULTS

Using LASSO regression, this study screened 13 possible risk factors. The dosage of DQ, gastric lavage rate, medication to hospital admission time, alanine aminotransferase, aspartate aminotransferase, blood potassium, creatinine, urea, partial pressure of oxygen, urinary DQ concentration, Systemic Inflammatory Response Syndrome (SIRS) score, Sequential Organ Failure Assessment (SOFA) score, and Acute Physiology and Chronic Health Evaluation (APACHE) II score were found to predict death significantly after acute DQ poisoning. This study further constructed the nomogram predictive model and validated the predictive performance of this model by using a validation set. The Area Under the Curve (AUC) of the training set was 0.961, and that of the validation set was 0.947. The calibration curve of the training and validation sets showed good prediction results of the model, and the calibration curve tended to approach the ideal curve.

CONCLUSION

This study constructed a nomogram model to predict mortality risk in patients with acute DQ poisoning. Clinicians will have a clearer and intuitive understanding of the prognosis of patients, so as to enhance the treatment of patients and optimize the allocation of medical resources.

摘要

目的

分析急性敌草快(DQ)中毒患者的死亡危险因素,并构建列线图预测模型用于临床评估和治疗。

方法

对2022年3月至2024年4月收治的110例急性DQ中毒患者的临床资料进行回顾性分析。将纳入的患者分为80例的训练集和30例的验证集。建立生存组和死亡组,以30天内死亡为终点。其中,训练组生存组67例,死亡组13例。本研究进一步分析比较两组患者的基线和临床资料,采用最小绝对收缩和选择算子(LASSO)回归筛选潜在危险因素,并通过多因素logistic回归分析确定独立危险因素。基于验证集构建并验证列线图预测模型。

结果

本研究采用LASSO回归筛选出13个可能的危险因素。发现敌草快剂量、洗胃率、用药至入院时间、谷丙转氨酶、谷草转氨酶、血钾、肌酐、尿素、氧分压、尿敌草快浓度、全身炎症反应综合征(SIRS)评分、序贯器官衰竭评估(SOFA)评分和急性生理与慢性健康状况评估(APACHE)Ⅱ评分可显著预测急性敌草快中毒后的死亡情况。本研究进一步构建列线图预测模型,并使用验证集验证该模型的预测性能。训练集的曲线下面积(AUC)为0.961,验证集的AUC为0.947。训练集和验证集的校准曲线显示模型具有良好的预测结果,且校准曲线趋于接近理想曲线。

结论

本研究构建了列线图模型来预测急性敌草快中毒患者的死亡风险。临床医生将对患者的预后有更清晰直观的认识,从而加强对患者的治疗并优化医疗资源分配。

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