老年骨盆骨折合并多发伤患者静脉血栓栓塞症发生风险的列线图预测模型构建及验证OA
Construction and validation of a nomogram prediction model for risk of venous thromboembolism in elderly patients with pelvic fractures complicated with multiple injuries
目的 构建预测老年骨盆骨折合并多发伤患者发生静脉血栓栓塞症(VTE)的列线图模型并验证其临床预测效能.方法 回顾性分析2020年1月-2025年12月南京医科大学附属江宁医院收治的300例骨盆骨折合并多发伤老年患者的临床资料.收集所有患者临床资料;采用多因素Logistic回归模型分析筛选患者发生VTE的影响因素;构建影响患者发生VTE的列线图风险预测模型,基于校准曲线与受试者工作特征(ROC)曲线验证构建模型.结果 300例患者中,102例(34.00％)发生VTE,设为VTE组,其余为非VTE组.与非VTE组相比,VTE组年龄、VTE病史比率、损伤严重度评分(ISS)、术前D-二聚体(D-D)水平更高,骨折至手术时间及住院时间更长,差异均有统计学意义(P＜0.05).多因素Logistic回归分析显示,年龄、VTE病史、ISS、骨折至手术时间、住院时间、术前D-D水平均是患者发生VTE的影响因素(P＜0.05).基于影响因素构建列线图模型,总分18～286分,对应风险范围0.10～0.80,分数越高提示发生VTE的风险越高.ROC曲线评估结果显示,该预测模型在判断老年骨盆骨折合并多发伤患者发生VTE方面表现优异,曲线下面积(AUC)为0.923(95％CI:0.886～0.950),灵敏度、特异度分别为95.10％、83.33％,约登指数为0.784;经Bootstrap法内部验证,校准曲线显示预测曲线与实际曲线高度一致(Hosmer-Lemeshowx2=0.746,P=0.584),提示模型区分度与校准度均表现良好.结论 老年骨盆骨折合并多发伤患者发生VTE的影响因素包括年龄、ISS、VTE病史、骨折至手术时间、住院时间及术前D-D水平,基于上述影响因素构建的风险预测模型对发生VTE具有较高的预测效能.
Objective To construct a nomogram model for predicting venous thromboembolism(VTE)in elderly patients with pelvic fractures complicated with multiple injuries and verify its clinical predictive performance.Methods A retrospective analysis was performed on the clinical data of 300 elderly patients with pelvic fractures complicated with multiple injuries in Jiangning Hospital Affiliated to Nanjing Medical University from January 2020 to December 2025.Clinical data of all patients were collected.A multivariate Logistic regression model was used to analyze and screen the influencing fac-tors for VTE in patients.A nomogram risk prediction model for VTE was constructed,and the estab-lished model was validated based on calibration curves and receiver operating characteristic(ROC)curves.Results Among the 300 included patients,102 cases(34.00％)developed VTE(VTE group).The patients without VTE were inclued in non-VTE group.Compared with the non-VTE group,the VTE group had higher age,higher proportion of patients with a history of VTE,higher Injury Severity Score(ISS),higher preoperative D-dimer(D-D)level,longer time from fracture to opera-tion,and longer length of hospital stay,with all differences being statistically significant(P＜0.05).Multivariate Logistic regression analysis showed that age,history of VTE,ISS,time from fracture to operation,length of hospital stay,and preoperative D-D level were all influencing factors for the occurrence of VTE in patients(P＜0.05).The nomogram model constructed based on these influencing factors had a total score ranging from 18 to 286 points,corresponding to a risk range of 0.10 to 0.80,and a higher score indicated a higher risk of VTE.ROC curve evaluation showed that this prediction model performed excellently in judging the occurrence of VTE in elderly patients with pelvic fractures complicated with multiple injuries,with an area under the curve(AUC)of 0.923(95％CI,0.886 to 0.950),a sensitivity of 95.10％,a specificity of 83.33％,and a Youden in-dex of 0.784.After internal validation by the Bootstrap method,the calibration curve showed that the predicted curve was highly consistent with the actual curve(Hosmer-Lemeshowx2=0.746,P=0.584),indicating that both the discrimination and calibration of the model performed well.Con-clusion The influencing factors for VTE in elderly patients with pelvic fractures complicated with multiple injuries include age,ISS,history of VTE,time from fracture to operation,length of hospi-tal stay,and preoperative D-D level.The risk prediction model constructed based on the above in-fluencing factors has high predictive performance for the occurrence of VTE.
陈雨薇;刘敏;魏芳玲;朱晓光
南京医科大学附属江宁医院急诊科,江苏南京,211100南京医科大学附属江宁医院急诊科,江苏南京,211100南京医科大学附属江宁医院急诊科,江苏南京,211100徐州医科大学附属医院急诊科,江苏徐州,221000
医药卫生
骨盆骨折多发伤静脉血栓栓塞症深静脉血栓形成肺栓塞损伤严重度评分列线图模型预测效能
pelvic fracturemultiple injuriesvenous thromboembolismdeep vein thrombo-sispulmonary embolisminjury severity scorenomogram modelpredictive performance
《实用临床医药杂志》 2026 (16)
26-31,39,7
江苏省科技项目(BL2020140)
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