目的:分析心脏病危重患者术后血小板减少的影响因素,构建列线图预测模型。
方法:收集2022年10月至2023年10月我院就诊的319例心脏病危重患者,根据患者术后血小板减少情况分为术后血小板减少组(142例)和术后无血小板减少组(177例)。应用Logistic回归分析筛选心脏病危重患者术后血小板减少的危险因素;应用R软件构建预测心脏病危重患者术后血小板减少的列线图,和ROC曲线,校正曲线,和Hosmer-Lemeshow拟合优度测试用于评估列线图。
结果:319名危重患者中有142名患者出现术后血小板减少症,占44.51%。Logistic回归分析显示性别(95%CI1.607~4.402,P=0.000),年龄≥60岁(95%CI1.380-3.697,P=0.001),术前抗血小板治疗(95%CI1.254-3.420,P=0.004),体外循环时间>120min(95%CI1.681~4.652,P=0.000)是重症心脏病患者术后血小板减少的独立危险因素。ROC曲线下面积为0.719(95%CI:0.663-0.774)。校准曲线的斜率接近1,Hosmer-Lemeshow拟合优度检验为χ2=6.422,P=0.491。
结论:心脏病危重患者术后血小板减少受性别影响,年龄≥60岁,术前抗血小板治疗,和体外循环时间>120分钟。基于上述多个独立危险因素建立的列线图为临床预测心脏病危重患者术后血小板减少的风险提供了一种方法。
OBJECTIVE: To analyze the influencing factors of postoperative thrombocytopenia in critically ill patients with heart disease and construct a nomogram prediction model.
METHODS: From October 2022 to October 2023, 319 critically ill patients with heart disease who visited our hospital were collected and separated into postoperative thrombocytopenia group (n = 142) and no postoperative thrombocytopenia group (n = 177) based on their postoperative thrombocytopenia, Logistic regression analysis was applied to screen risk factors for postoperative thrombocytopenia in critically ill patients with heart disease; R software was applied to construct a nomogram for predicting postoperative thrombocytopenia in critically ill patients with heart disease, and ROC curves, calibration curves, and Hosmer-Lemeshow goodness of fit tests were applied to evaluate nomogram.
RESULTS: A total of 142 out of 319 critically ill patients had postoperative thrombocytopenia, accounting for 44.51%. Logistic regression analysis showed that gender (95% CI 1.607-4.402, P = 0.000), age ≥ 60 years (95% CI 1.380-3.697, P = 0.001), preoperative antiplatelet therapy (95% CI 1.254-3.420, P = 0.004), and extracorporeal circulation time > 120 min (95% CI 1.681-4.652, P = 0.000) were independent risk factors for postoperative thrombocytopenia in critically ill patients with heart disease. The area under the ROC curve was 0.719 (95% CI: 0.663-0.774). The slope of the calibration curve was close to 1, and the Hosmer-Lemeshow goodness of fit test was χ2 = 6.422, P = 0.491.
CONCLUSIONS: Postoperative thrombocytopenia in critically ill patients with heart disease is influenced by gender, age ≥ 60 years, preoperative antiplatelet therapy, and extracorporeal circulation time > 120 min. A nomogram established based on above multiple independent risk factors provides a method for clinical prediction of the risk of postoperative thrombocytopenia in critically ill patients with heart disease.