老年髋部骨折患者个体化术后谵妄风险预测模型的构建及验证

王天沛; 蔡永松; 郭华; 孙叶; 曹军军; 杨寅

doi:10.16016/j.2097-0927.202110045

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老年髋部骨折患者个体化术后谵妄风险预测模型的构建及验证

临床医学 | 更新时间：2026-01-09

- 老年髋部骨折患者个体化术后谵妄风险预测模型的构建及验证
- Establishment and validation of a risk prediction model for postoperative delirium in elderly patients after individualized hip fracture surgery
- 陆军军医大学学报 2022年44卷第6期页码：563-570
- 作者机构：
  
  1.712046 陕西咸阳，陕西中医药大学研究生院
  2.710003 西安，西安市中心医院骨二科
  3.710054 西安，西安交通大学医学院附属红会医院关节外科
- 作者简介：
  
  [ 杨寅，E-mail: yydoctor@126.com YANG Yin, E-mail: yydoctor@126.com
- 基金信息：
  
  陕西省重点研发计划(2020SF-197);陕西省科技计划项目(2021JZ-58);陕西省卫生健康委员会项目(2021B001);应用基础研究项目(2021)
- DOI：10.16016/j.2097-0927.202110045
  中图分类号： R311;R683.306;R749.1
- 收稿：2021-10-11，
  
  修回：2021-12-12，
  
  纸质出版：2022-03-30
- 稿件说明：
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王天沛, 蔡永松, 郭华, 等. 老年髋部骨折患者个体化术后谵妄风险预测模型的构建及验证[J]. 陆军军医大学学报, 2022,44(6):563-570.

Tianpei WANG, Yongsong CAI, Hua GUO, et al. Establishment and validation of a risk prediction model for postoperative delirium in elderly patients after individualized hip fracture surgery[J]. Journal of Army Medical University, 2022, 44(6): 563-570.
王天沛, 蔡永松, 郭华, 等. 老年髋部骨折患者个体化术后谵妄风险预测模型的构建及验证[J]. 陆军军医大学学报, 2022,44(6):563-570. DOI： 10.16016/j.2097-0927.202110045.

Tianpei WANG, Yongsong CAI, Hua GUO, et al. Establishment and validation of a risk prediction model for postoperative delirium in elderly patients after individualized hip fracture surgery[J]. Journal of Army Medical University, 2022, 44(6): 563-570. DOI： 10.16016/j.2097-0927.202110045.

摘要

目的

构建并验证老年髋部骨折患者个体化术后谵妄风险预测模型。

方法

回顾性分析2016年12月至2021年1月393例西安市中心医院骨科行手术治疗的老年髋部骨折住院患者的临床数据，将2016年12月至2020年7月收集的333例患者的临床数据作为模型训练集，以术后发生谵妄为研究终点，基于模型训练集，利用单因素和多因素Logistic回归筛选出术后谵妄的独立相关因素。通过回归系数建立模型，结合R语言的rms包绘制列线图，并对模型进行区分度、校准度及临床适用性检验。利用Bootstrap在训练集中重复抽样1 000次对模型进行内部验证，另收集2020年8月至2021年1月在西安市中心医院骨科行手术治疗的60例老年髋部骨折住院患者的临床数据作为验证集对模型进行外部验证。

结果

共纳入393例老年髋部骨折患者，训练集333例，验证集60例。单因素和多因素Logistic分析显示，痴呆、术前白蛋白水平、术中低血压为老年髋部骨折患者术后谵妄的独立相关因素。根据各相关因素及回归系数得出预测模型:

=1/(1+e

-Z

)，

=1.396×是否痴呆-0.275×术前白蛋白水平+1.420×是否术中低血压+6.875。训练集中模型的截断值为0.235，特异度和灵敏度分别为0.875和0.622，验证集中模型的截断值为0.211，特异度和灵敏度均为0.800，训练集及验证集受试者工作特征曲线(receiver operating characteristic curve

ROC)下面积(area under curve

AUC)分别为0.827 (95%

：0.762~0.892)和0.836 (95%

：0.716~0.956)，通过Bootstrap重复抽样1 000次后模型内部验证的AUC为0.831。训练集及验证集校准曲线的斜率分别为1和1.066，Hosmer-Lemeshow拟合优度检验的

值分别为0.124和0.743，临床决策曲线显示在训练集及验证集中模型预测术后谵妄的最大净获益值阈值概率区间分别在5%~90%和3%~90%。

结论

构建的模型可对老年髋部骨折患者术后谵妄的风险进行预测。

Abstract

Objective

To establish and verify a postoperative delirium risk prediction model for elderly patients after individualized hip fracture surgery.

Methods

Clinical data of 393 elderly patients with hip fracture who underwent surgical treatment in the Department of Orthopedics

Xi'an Central Hospital from December 2016 to January 2021 were collected retrospectively in this study. The data from 333 patients during December 2016 and July 2020 were used as the model training set

and postoperative delirium was regarded as the research endpoint. Based on the model training set

uniuariate and multivariate logistic regression were adopted to screen out independent related factors of postoperative delirium. The model was established by regression coefficient

the nomogram was drawn combined with the rms package of R language

and the discrimination

calibration and clinical applicability of the model were tested. Bootstrap was used to repeatedly sample 1 000 times in the training set for internal verification of the model

and the data of 60 patients treated from August 2020 to January 2021 were employed as the verification set for external verification of the model.

Results

There were 393 elderly patients with hip fracture

including 333 cases in the training set

and 60 cases in the validation set. Univariate and multivariate logistic analysis showed that dementia

preoperative albumin level and intraoperative hypotension were independent related factors of postoperative delirium in elderly patients with hip fracture. The prediction model is obtained according to the relevant factors and regression coefficients: P=1/(1+e

-Z

)

Z=1.396×dementia or not -0.275× preoperative albumin level +1.420×intraoperative hypotension or not +6.875. The cut-off value of the model in the training set is 0.235

and the specificity and sensitivity is 0.875 and 0.622

respectively. The cut-off value of the model in the validation set is 0.211

and the specificity and sensitivity is 0.800 and 0.800

respectively. The area under curve (AUC) of the receiver operating characteristic curve (ROC) in the training set and the validation set is 0.827 (95%

: 0.762~0.892) and 0.836 (95%

: 0.716~0.956) respectively. After 1 000 repeated sampling by bootstrap

the AUC of the internal verification of the model is 0.831. The slopes of the calibration curves of the training set and the validation set is 1 and 1.066

respectively. The

values of the Hosmer-Lemeshow goodness-of-fit test are 0.124 and 0.743

respectively. The clinical decision curve showed that the threshold probability interval of the maximum net benefit value of the postoperative delirium predicted by the model in the training set and the validation set was about 5%~90% and 3%~90% respectively.

Conclusion

Our established model can predict the risk of postoperative delirium in elderly patients after hip fracture surgery.

关键词

Keywords

references

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