基于列线图模型的血液透析患者透析中低血压风险预测与评估OA

Objective To investigate the risk factors for intradialytic hypotension(IDH)in maintenance hemodialysis(MHD)patients,and to develop a nomogram model to predict the risk of IDH and evaluate the model's predictive value.Methods A retrospective analysis was conducted on clinical data from 200 MHD patients at the Blood Purification Center of Beijing Luhe Hospital,Capital Medical University,between April 1 and June 30,2022.Temporal validation was performed using data of these patients from October 1 to December 31,2021.Univariate and multivariate logistic regression analyses were used to identify independent risk factors for IDH,and a nomogram prediction model was established.The calibration and discrimination of the model were evaluated using calibration curves and ROC curves,and a decision curve analysis(DC A)was performed to assess its clinical utility.Results Pre-dialysis systolic blood pressure(OR=0.974,95％CI:0.953-0.995;P=0.018),blood urea nitrogen(OR=0.927,95％CI:0.862-0.997;P=0.042),and neutrophil-to-lymphocyte ratio(NLR;OR=1.504,95％CI:1.204-1.880;P＜0.001)were identified as independent risk factors for intradialytic hypotension(IDH).A nomogram prediction model for intradialytic hypotension(IDH)occurrence in MHD patients was constructed based on the aforementioned factors and albumin levels.The area under the ROC curve(AUC)was 0.751(95％CI:0.675-0.827)in the training set and 0.729(95％CI:0.642-0.817)in the validation set.The calibration curve of the validation set demonstrated good fit by the Hosmer-Lemeshow test(x2=7.694,P=0.464);decision curve analysis(DCA)indicated enhanced clinical net benefit when the threshold probability ranged from 0.17 to 0.80.Conclusion The nomogram model for predicting IDH constructed based on predialysis systolic blood pressure,blood urea nitrogen,NLR,and albumin is simple and practical,and has high accuracy,demonstrating certain clinical application value.