常规检验数据挖掘对急性缺血性脑卒中并发卒中相关肺炎的预测价值
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叙永县中医医院检验科, 四川 叙永 646400

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秦昌宏  E-mail: 58736753@qq.com

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Predictive value of routine testing data mining for acute ischemic stroke complicated with stroke-associated pneumonia
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Department of Laboratory Medicine, Xuyong Hospital of Chinese Medicine, Xuyong 646400, China

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    摘要:

    目的 通过对常规检验数据的挖掘分析, 充分发挥其剩余价值, 为急性缺血性脑卒中并发卒中相关性肺炎(SAP)提供辅助预测价值。 方法 回顾性分析某院2019年6月—2021年6月收治的急性缺血性脑卒中病例, 根据是否并发SAP分为SAP组和非SAP组, 以7∶3比例分为训练集和测试集。收集2021年7月—2022年6月收治的急性缺血性脑卒中病例作为验证集。通过最小绝对收缩和选择算子(LASSO)筛选出与SAP有关的检验参数, 使用训练集、测试集和验证集构建、验证联合预测列线图模型。预测模型分别采用受试者工作特征(ROC)曲线评估区分度, 校准曲线评估校准度, 临床决策曲线(DCA)评估临床实用性。将列线图模型布置成网页计算器, 提高临床实用价值。 结果 共纳入379例急性缺血性脑卒中患者作为研究的基本人群, 其中SAP 42例, 发病率为11.08%;以7∶3分配方式, 分为训练集265例, 测试集114例。2021年7月—2022年6月收治的157例急性缺血性脑卒中病例作为验证集, 其中SAP 24例, 发病率为15.29%。LASSO筛选出5个与SAP有关的检验参数分别为中性粒细胞(NEU)、淋巴细胞(LYM)、前清蛋白(PA)、纤维蛋白原(Fib)、D-二聚体; 校准曲线显示训练集和测试集的预测概率和实际概率相一致, 具有较好的校准度; DCA曲线显示训练集高风险阈值为0~0.75, 净获益为0~0.11。测试集高风险阈值为0~0.65, 净获益为0~0.11, 具有较好的临床实用性。ROC曲线显示全数据集联合预测曲线下面积(AUC)为0.924, 灵敏度为83.33%, 特异度为87.24%。训练集联合预测AUC为0.922, 灵敏度为79.31%, 特异度为91.95%。测试集联合预测AUC为0.919, 灵敏度为84.62%, 特异度为86.14%, 均具有良好的区分性能。验证集联合预测AUC为0.850, 灵敏度为66.67%, 特异度为89.47%, 模型具有较好的外部适用性。网页计算器布置在https://ww-rstudiomn.shinyapps.io/SAP-nomgram/上, 可通过二维码访问, 经过测试, 性能稳定。 结论 通过常规检验数据的挖掘, 对急性缺血性脑卒中并发SAP的预测提供了一定临床价值, 为早期的治疗和干预提供依据。

    Abstract:

    Objective Through mining and analyzing the routine test data to develop its residual value and provide auxiliary predictive value for acute ischiic stroke (AIS) complicated with stroke-associated pneumonia (SAP). Methods AIS patients admitted to a hospital from June 2019 to June 2021 were retrospectively analyzed, divided into SAP group and non-SAP group according to whether they were complicated with SAP, and subdivided into trai-ning set and testing set at a ratio of 7 ∶3. AIS patients admitted to hospital from July 2021 to June 2022 were collected as the validation set. SAP-related test parameters were screened by the least absolute shrinkage and selection operator (LASSO). Nomogram model of the combined prediction was constructed and validated with training set, testing set and verification set. Discrimination and calibration of prediction model were assessed by receiver operating chara-cteristic (ROC) curve and calibration curve respectively, clinical practicability was assessed by decision curve analysis (DCA). Nomograph model was arranged into a web calculator to improve the clinical practical value. Results A total of 379 patients with AIS were taken as the basic population of the study, including 42 cases (incidence 11.08%) in SAP group. According to the 7 ∶3 distribution method, 265 cases were divided in training set and 114 in testing set.157 cases of AIS admitted from July 2021 to June 2022 were used as validation set, including 24 cases (incidence 15.29%) in SAP group. Five test parameters related to SAP were screened out by LASSO, namely neutrophil, lymphocyte, prealbumin, fibrinogen, and D-dimer. The calibration curve showed good calibration that the predicted probability of training set and testing set was consistent with the actual probability. DCA curve showed that the high risk threshold of training set was 0-0.75 and the net benefit was 0-0.11. The high risk threshold of testing set was 0-0.65, the net benefit was 0-0.11, with good clinical practicability. ROC curve showed that area under curve (AUC) predicted by full data set was 0.924, the sensitivity and specificity were 83.33% and 87.24% respectively. AUC predicted by training set was 0.922, the sensitivity and specificity were 79.31%, and 91.95% respectively. AUC predicted by testing sets was 0.919, sensitivity and specificity were 84.62% and 86.14% respectively, all of which had good discrimination performance. AUC predict by validation set was 0.850, sensitivity and specificity were 66.67% and 89.47% respectively. The model has good external applicability. The web calculator was arranged at https://ww-rstudiomn.shinyapps.io/SAP-nomgram/, which can be accessed via QR code. Test showed that the performance was stable. Conclusion The mining of routine test data provides a clinical value for the prediction of AIS complicated with SAP, thus provides a basis for early treatment and intervention.

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引用本文

曾瑞璜,陈智熙,王小林,等.常规检验数据挖掘对急性缺血性脑卒中并发卒中相关肺炎的预测价值[J]. 中国感染控制杂志,2023,(2):142-149. DOI:10.12138/j. issn.1671-9638.20233331.
Rui-huang ZENG, Zhi-xi CHEN, Xiao-lin WANG, et al. Predictive value of routine testing data mining for acute ischemic stroke complicated with stroke-associated pneumonia[J]. Chin J Infect Control, 2023,(2):142-149. DOI:10.12138/j. issn.1671-9638.20233331.

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  • 收稿日期:2022-09-05
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  • 在线发布日期: 2024-04-28
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