Abstract：
Intraoperative hemorrhage is an important factor affecting intraoperative safety and postoperative patient recovery in percutaneous nephrolithotomy (PCNL). This study aimed to identify the factors that influence intraoperative hemorrhage during PCNL and develop a predictive nomogram model based on these factors.A total of 118 patients who underwent PCNL at the Department of Urology, The Affiliated Huai\'an No.1 People\'s Hospital of Nanjing Medical University from January 2021 to September 2023 was included in this study. The patients were divided into a hemorrhage group (58 cases) and a control group (60 cases) based on the decrease in hemoglobin levels after surgery. The clinical data of all patients were collected, and both univariate analysis and multivariate logistic regression analysis were conducted to identify the independent risk factors for intraoperative hemorrhage during PCNL. The independent risk factors were used to construct a nomogram model using R software. Additionally, receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA) were utilized to evaluate the model.Multivariate logistic regression analysis revealed that diabetes, long operation time and low psoas muscle mass index (PMI) were independent risk factors for intraoperative hemorrhage during PCNL (P < 0.05). A nomogram model was developed incorporating these factors, and the areas under the ROC curve (AUCs) in the training set and validation set were 0.740 (95% CI: 0.637-0.843) and 0.742 (95% CI: 0.554-0.931), respectively. The calibration curve and Hosmer-Lemeshow test (P = 0.719) of the model proved that the model was well fitted and calibrated. The results of the DCA showed that the model had high value for clinical application.Diabetes, long operation time and low PMI were found to be independent risk factors for intraoperative hemorrhage during PCNL. The nomogram model based on these factors can be used to predict the risk of intraoperative hemorrhage, which is beneficial for perioperative intervention in high-risk groups to improve the safety of surgery and reduce the incidence of postoperative complications.
摘要：
术中出血是影响经皮肾镜取石术(PCNL)术中安全性和术后患者恢复的重要因素。本研究旨在确定影响PCNL术中出血的因素，并基于这些因素建立预测列线图模型。共有118名在泌尿外科接受PCNL的患者，本研究纳入2021年1月至2023年9月南京医科大学附属淮安第一人民医院。根据手术后血红蛋白水平下降分为出血组(58例)和对照组(60例)。收集所有患者的临床资料,采用单因素分析和多因素logistic回归分析确定PCNL术中出血的独立危险因素。利用R软件构建独立危险因素的列线图模型。此外,接收机工作特性(ROC)曲线，校正曲线和决策曲线分析(DCA)用于评估模型。多因素logistic回归分析显示，糖尿病，手术时间长、腰大肌质量指数（PMI）低是PCNL术中出血的独立危险因素（P<0.05）。结合这些因素开发了一个列线图模型，训练集和验证集的ROC曲线下面积（AUC）分别为0.740（95％CI：0.637-0.843）和0.742（95％CI：0.554-0.931），分别。模型的校正曲线和Hosmer-Lemeshow检验（P=0.719）证明了模型的拟合和校准效果。DCA结果表明该模型具有较高的临床应用价值。糖尿病,手术时间长、PMI低是PCNL术中出血的独立危险因素。基于这些因素的列线图模型可用于预测术中出血的风险，有利于高危人群的围手术期干预,提高手术安全性,降低术后并发症发生率。
