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创伤性凝血病早期风险预测模型的构建

Construction of an Early-stage Risk Prediction Model for Trauma-Induced Coagulopathy

  • 摘要:
    目的 基于前瞻性收集的创伤患者入院早期临床资料和实验室数据,构建并验证用于早期评估急诊创伤患者并发创伤性凝血病(trauma-induced coagulopathy, TIC)的风险预测模型。
    方法 本研究分析了2024年1月–2024年12月期间收治的285例急诊创伤患者的临床资料和实验室数据。按7∶3比例将患者随机分为训练集(n=199)与测试集(n=86)。通过单因素与多因素logistic回归分析筛选TIC的独立预测因素并构建风险预测模型。采用受试者工作特征曲线下面积(area under the curve, AUC)评估模型的诊断效能,使用Bootstrap法绘制校准曲线以评估校准度,并利用决策曲线分析(decision curve analysis, DCA)评价其临床净获益。
    结果 多因素logistic回归分析确定头部创伤、平均动脉压(mean arterial pressure, MAP)、凝血酶原时间(prothrombin time, PT)和凝血酶时间(thrombin time, TT)为TIC的独立预测因素,并成功构建预测模型。该模型在训练集中的AUC为0.804〔95%置信区间(confidence interval, CI):0.737~0.871〕,在测试集中的AUC为0.847(95%CI:0.767~0.927)。校准曲线显示模型预测概率与实际概率高度一致,DCA表明该模型在较宽的风险阈值范围内(0.2~1.0)具有显著的临床净获益。
    结论 本研究成功构建并验证了TIC风险预测模型,该模型对急诊创伤患者并发TIC具有良好的早期预测效能。

     

    Abstract:
    Objective Based on prospectively collected early clinical and laboratory data from trauma patients at admission, a risk prediction model for the early assessment of trauma-induced coagulopathy (TIC) in emergency trauma patients was constructed and validated.
    Methods This study analyzed the clinical data and laboratory results of 285 emergency trauma patients admitted between January 2024 and December 2024. The patients were randomly divided into a training set (n = 199) and a test set (n = 86) at a 7∶3 ratio. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of TIC and to construct a risk prediction model. The diagnostic efficacy of the model was evaluated by the area under the receiver operating characteristic curve (AUC). The calibration curve was plotted using the Bootstrap method to assess calibration, and the clinical net benefit was evaluated by decision curve analysis (DCA).
    Results Multivariate logistic regression analysis identified head trauma, mean arterial pressure (MAP), prothrombin time (PT), and thrombin time (TT) as independent predictors of TIC, and a predictive model was developed. The AUC of the model was 0.804 (95% CI: 0.737-0.871) in the training set and 0.847 (95% CI: 0.767-0.927) in the test set. The calibration curve showed a high level of agreement between the predicted and actual probabilities. DCA indicated that the model provided significant clinical net benefit across a broad range of risk thresholds (0.2-1.0).
    Conclusion This study developed and validated a TIC risk prediction model that demonstrated excellent early predictive efficacy for TIC in emergency trauma patients.

     

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