Establishment of nomogram model for predicting urosepsis after endourological surgery for kidney stones
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摘要: 目的 建立和验证预测肾结石腔内手术后发生尿脓毒症的列线图预测模型。方法 回顾性分析2018年1月—2021年5月于天津市第四中心医院和天津医科大学第二医院行肾结石腔内手术治疗患者的临床资料，通过logistic回归分析确定术后发生尿脓毒症的危险因素并建立列线图预测模型。使用受试者工作特征曲线(ROC)评价列线图的预测能力，使用内部验证(Bootstrap自抽样)方法和一致性指数(C-index)检验证列线图预测效果的准确性。使用决策曲线分析(DCA)分析列线图的临床实用价值。结果 共纳入724例肾结石手术患者，其中有38例患者术后发生了尿脓毒症，logistic回归分析显示：女性(OR=2.451，95%CI：1.044~4.574，P=0.038)、糖尿病病史(OR=2.412，95%CI：1.217~5.161，P=0.013)、术前尿白细胞升高(OR=1.955，95%CI：1.049~4.516，P=0.037)、尿培养阳性(OR=3.683，95%CI：2.434~10.059，P=0.001)、中或重度肾积水(OR=2.491，95%CI：1.500~6.349，P=0.002)是肾结石腔内手术后发生尿脓毒症的危险因素，使用上述危险因素通过R语言建立列线图预测模型。列线图模型预测尿脓毒症风险的ROC曲线下面积(AUC)为0.754，P< 0.05。模型校准图显示预测概率与实际发生概率趋于一致。结论 通过验证的列线图预测模型对肾结石腔内手术后发生尿脓毒症的风险具有较好的预测效能，同时也是改善围术期管理的实用诊疗工具。Abstract: Objective To establish and validate a prognostic nomogram model for predicting the occurrence of urosepsis after endourological surgery of renal stone.Methods Clinical data of 724 cases at Tianjin Fourth Central Hospital and Tianjin Medical University Second Hospital from January 2018 to May 2021 were retrospectively reviewed, and all patients underwent endourological surgery for kidney stones. Logistic regression was used to identify the risk factors for the development of postoperative urosepsis, and the prognostic nomogram model was established. The receiver operating characteristic(ROC) curve was used to evaluate the predictive ability of the model, and the Bootstrap method was used for internal verification by repeating sample for 1 000 times. Decision curve analysis (DCA) was applied to analyze the clinical practical value of the model.Results A total of 724 patients were included, and 38 patients had postoperative urosepsis. Logistic regression analysis showed that female (OR=2.451, 95%CI: 1.044-4.574,P=0.038), diabetes mellitus (OR=2.412, 95%CI: 1.217-5.161,P=0.013), preoperative elevated urine WBC (OR=1.955, 95%CI: 1.049-4.516,P=0.037), urine culture positive (OR=3.683, 95%CI: 2.434-10.059,P=0.001), hydronephrosis (OR=2.491, 95%CI: 1.500-6.349,P=0.002) were the risk factors of postoperative urosepsis. The nomogram prediction model was established by the above risk factors. ROC curve analysis showed that the area under the ROC curve (AUC) of nomogram model to predict the risk of postoperative urosepsis was 0.754. The model calibration chart showed that the predicting probability was consistent with the actual occurrence probability.Conclusion The validated prognostic nomogram model has good prediction efficiency for the risk of postoperative urosepsis of renal stone, and it's also a practical theragnostic tool to improve perioperative management.
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Key words:
- renal stone /
- endourological surgery /
- urosepsis /
- risk factors /
- nomogram
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表 表 1 组间单因素分析结果
单因素 试验组
(n=38)对照组
(n=686)t/χ2 P值 年龄/岁 54.18± 10.142 52.93± 11.888 0.636 0.094 BMI/(kg·m-2) 23.61± 3.665 24.02± 3.703 -0.666 0.897 性别 7.311 0.007 女 23 264 男 15 422 侧别 0.031 0.859 左 21 369 右 17 317 高血压 1.086 0.297 是 10 316 否 28 370 糖尿病 6.890 0.009 是 15 146 否 23 540 术前发热 4.357 0.037 是 9 83 否 29 603 尿白细胞 4.300 0.038 升高 16 186 正常 22 500 尿培养 16.783 0.001 阳性 20 159 阴性 18 527 肾积水 7.597 0.006 无或轻度 16 155 中或重度 22 531 结石大小 0.303 0.582 <2 cm 15 302 ≥2 cm 23 384 鹿角形结石 5.187 0.023 是 12 117 否 26 569 手术方式 2.494 0.114 PCNL 15 325 RIRS 23 361 
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