社区老年高血压患者衰弱的动态列线图风险预测模型构建
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女,硕士在读,学生

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山东省2019-2020年度中医药科技发展计划项目(2019-0002);山东中医药大学高等教育发展规划研究2022年度课题(GJYJY202212)


Web-based dynamic nomogram for predicting frailty in community elderly patients with hypertension
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    摘要:

    目的 构建动态列线图预测模型,分析社区老年高血压患者衰弱的影响因素,为制定针对性的干预措施提供参考。 方法 从中国健康与养老追踪调查随访数据库中提取高血压患者信息,以7∶3比例随机分为训练集(n=1 160)与验证集(n=494)。采用Lasso法筛选最佳预测变量,使用logistic回归模型分析高血压患者衰弱影响因素,并构建动态列线图。使用ROC曲线的曲线下面积、Hosmer-Lemeshow检验、校准曲线和决策曲线分析评估列线图的预测性能。 结果 共筛选出1 654例老年高血压患者,其中560例(33.86%)并发衰弱。受教育程度、握力、BMI、抑郁、认知障碍、自评健康、代谢性疾病、心脑血管疾病、呼吸系统疾病、胃肠道疾病10个变量纳入预测模型。预测模型在训练集和验证集的ROC曲线下面积分别为0.883(95%CI为0.863~0.903)和0.887(95%CI为0.857~0.916);Hosmer-Lemeshow检验值分别为P=0.825和P=0.410;校准曲线显示预测值和实际值之间存在显著一致性。决策曲线分析显示该模型具有良好的净效益和预测准确性。 结论 动态列线图具有良好预测性能,可为社区医护人员评估高血压患者衰弱风险提供便捷有效的工具。

    Abstract:

    Objective To construct a dynamic nomogram prediction model, to analyze the influencing factors of frailty in elderly patients with hypertension in the community, and to provide a reference for developing targeted intervention. Methods Information on patients with hypertension was extracted from the China Health and Retirement Longitudinal Survey and randomly divided into a training set (n=1 160) and a validation set (n=494) in a ratio of 7∶3.The best predictors were screened by using LASSO me-thod, and the logistic regression model was used to analyze the influencing factors of frailty in hypertensive patients and develop a nomogram prediction model. Area under the ROC curve (AUC), Hosmer-Lemeshow test, calibration curve and decision curve analysis (DCA) were used to evaluate the predictive performance of the nomogram prediction model. Results A total of 1 654 elderly hypertensive patients were screened, of whom 560 (33.86%) were complicated by frailty. Such 10 variables as education level, grip strength, BMI, depression, cognitive impairment, self-rated health, metabolic diseases, cardiovascular/cerebrovascular diseases, respiratory diseases, and gastrointestinal diseases were included in the prediction model. The AUC of the ROC curve of the prediction model were 0.883 (95%CI:0.863-0.903)in the training set and 0.887 (95%CI:0.857-0.916) in the validation set respectively.The P value of the Hosmer-Lemeshow test was 0.825 in the training set and 0.410 in the validation set respectively. The calibration curves showed a favorable consistency between predicted and actual values. DCA showed that the model had good net benefits and predictive accuracy. Conclusion This dynamic nomogram has good predictive performance, which can serve as a convenient and effective tool for community medical staff to assess the risk of frailty in patients with hypertension.

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李洋洋,刘艳丽,秦玉婷,王鑫源,罗姣,刘小菲,胡重蝶,侯富文.社区老年高血压患者衰弱的动态列线图风险预测模型构建[J].护理学杂志,2023,28(23):84-90

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  • 收稿日期:2023-07-13
  • 最后修改日期:2023-09-25
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  • 在线发布日期: 2024-01-13