无抗凝剂血液透析凝血风险预测模型的开发与验证：提高血液透析对患者的安全性。

IF 2.2 3区医学 Q3 HEMATOLOGY

Blood Purification Pub Date : 2024-11-19 DOI:10.1159/000542422

Shufan Chen, Yun Chen, Wei Zhang, Haihan Li, Zining Guo, Keyu Ling, Xiaoli Yu, Fei Liu, Xiaoping Zhu

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引用次数: 0

摘要

简介本研究旨在开发和验证一种风险预测模型，用于预测接受无抗凝剂血液透析（HD）患者发生凝血的可能性。对于有全身治疗禁忌症的患者来说，无抗凝剂血液透析技术是必要的。凝血是该技术的并发症之一。遗憾的是，目前还没有预测模型来评估无抗凝剂血液透析中的凝血风险：我们回顾性分析了 2022 年 1 月至 2023 年 6 月期间接受无抗凝剂 HD 治疗的 164 名患者的 299 次 HD 治疗的临床数据。为了确定无抗凝剂 HD 中凝血的风险因素，我们对 18 个独立变量进行了单变量分析。通过确定导致无抗凝剂 HD 患者凝血的因素，使用 Logistic 回归建立预测模型。利用回归系数和 1000 次引导重复绘制了校准曲线，以在内部验证我们的模型。使用接收者操作特征（ROC）、曲线下面积（AUC）和决策曲线分析（DCA）对预测模型的性能进行了评估：无抗凝剂 HD 患者的凝血发生率为 35.1%。逻辑回归分析表明，血小板（PLT）血细胞比容（HCT）水平、透析液类型和年龄是无抗凝剂 HD 患者发生凝血的风险因素（PConclusion：在无抗凝剂的血液透析患者中，凝血风险因素众多，凝血发生率为 35.1%。所构建的凝血风险预测模型具有良好的预测性和临床实用性，可作为无抗凝剂 HD 患者凝血风险初步评估和筛查的参考。

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Development and Validation of a Coagulation Risk Prediction Model for Anticoagulant-Free Hemodialysis: Enhancing Hemodialysis Safety for Patients.

Introduction: This study aims to develop and validate a risk prediction model for predicting the likelihood of coagulation in patients undergoing anticoagulant-free hemodialysis (HD). Anticoagulant-free HD technique is necessary in patients with contraindications to systemic therapy. Coagulation is a complication of this technique. Unfortunately, no predictive model is currently available to assess the risk of coagulation in anticoagulant-free HD.

Methods: We retrospectively analyzed the clinical data from 299 HD sessions involving 164 patients who underwent anticoagulant-free HD between January 2022 and June 2023. To identify the risk factors for coagulation in anticoagulant-free HD, a univariate analysis was performed on 18 independent variables. Logistic regression was used to establish predictive models by identifying factors contributing to coagulation in anticoagulant-free HD. A calibration curve was drawn using regression coefficients and 1000 bootstrap repetitions to validate our model internally. The performance of the prediction model was evaluated using receiver operating characteristic (ROC), area under the curve (AUC), and decision curve analysis (DCA).

Results: The incidence of coagulation in patients on anticoagulant-free HD was 35.1%. Logistic regression analysis showed that platelet (PLT) hematocrit (HCT) levels, dialysate type, and age were risk factors for coagulation in anticoagulant-free HD patients (P<0.05). The Hosmer-Lemeshow test showed P= 0.29, and the AUC is 0.76 (95% CI 0.70-0.80). The optimal critical value was 0.40, yielding a sensitivity of 61.0%, a specificity of 80.4%, and a Youden index of 0.41.

Conclusion: In anticoagulant-free HD, there were numerous risk factors and a 35.1% occurrence of coagulation. The constructed coagulation risk prediction model exhibited good predictive and clinical utility and could serve as a reference for the initial assessment and screening of coagulation risk in anticoagulant-free HD.

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来源期刊

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.