Construction and validation of a risk prediction model for central venous catheter-associated deep venous thromboses in children with congenital heart disease after surgery

doi:10.3761/j.issn.0254-1769.2022.18.007

Abstract

Abstract:

Objective To construct a risk prediction model for central venous catheter-associated deep venous thrombosis（CADVT） in children with congenital heart disease after surgery,and to verify the prediction effect of the model. Methods A total of 234 children hospitalized in the cardiac care unit of a tertiary first-class pediatric hospital in Zhejiang Province from January to November 2021 were conveniently selected as the model building subjects. According to whether CADVT occurred,they were divided into a CADVT group（53 cases） and a non-CADVT group（181 cases）. Logistic regression analysis was used to establish the risk prediction model. Hosmer-Lemeshow test was used to determine the goodness of fit of the model. The receiver operator characteristic curve （ROC） was used to test the prediction effect of the model,and a nomogram model was drawn. 60 children with congenital heart disease after surgery in the same hospital from December 2021 to February 2022 were selected as the validation group,and Hosmer-Lemeshow test and ROC curve were used for external verification of the model. Results The incidence of CADVT in children with congenital heart disease after surgery was 22.65%. Intubation duration（OR=1.172）,D-dimer concentration（OR=1.169）,fibrinogen concentration（OR=3.888）,days of sedation（OR=1.538）,using of vasoconstrictor（OR=3.554） and pediatric critical illness score（OR=3.308） were its risk factors（P<0.05）. The Hosmer-Lemeshow test showed that χ²=4.456,P=0.814,the area under the ROC curve was 0.957（95%CI：0.930~0.984）,the optimal critical value was 0.813,the sensitivity was 0.962,and the specificity was 0.851. In the external validation,the sensitivity,specificity and accuracy of the model were 0.857,0.870,86.67%,respectively. Conclusion The risk prediction model constructed in this study has good effects,which can provide a reference for clinical evaluation of the risk of CADVT in children with congenital heart disease after surgery.

Key words: Congenital Heart Deformity, Central Venous Catheter, Venous Thrombosis, Risk, Prediction Model, Pediatric Nursing

摘要：

目的构建先天性心脏病术后患儿中心静脉导管相关深静脉血栓（central venous catheter-associated deep venous thromboses,CADVT）风险预测模型,并验证该模型的预测效果。方法便利选取2021年1月—11月在浙江省某三级甲等儿童专科医院心脏外科监护室住院的234例患儿作为建模组,根据是否发生CADVT,将其分为CADVT组（53例）和非CADVT组（181例）。采用Logistic回归分析建立风险预测模型,采用Hosmer-Lemeshow检验判断模型的拟合优度,采用受试者操作特征曲线（receiver operator characteristic curve,ROC）检测模型的预测效果,并绘制列线图。选取2021年12月—2022年2月同一所医院收治的60例先天性心脏病术后患儿作为验证组,采用Hosmer-Lemeshow检验和ROC曲线对模型进行外部验证。结果先天性心脏病术后患儿CADVT发生率为22.65%。CVC留置时长（OR=1.172）、D-二聚体浓度（OR=1.169）、纤维蛋白原浓度（OR=3.888）、镇静天数（OR=1.538）、使用血管收缩药（OR=3.554）和儿科危重病例评分（OR=3.308）是其风险因素（P<0.05）。Hosmer-Lemeshow检验结果显示, χ²=4.456,P=0.814,ROC曲线下面积为0.957（95%CI：0.930~0.984）,最佳临界值为0.813,灵敏度为0.962,特异度为0.851。外部验证结果显示,该模型的灵敏度为0.857,特异度为0.870,正确率为86.67%。结论该风险预测模型的预测效果良好,可为临床评估先天性心脏病术后患儿CADVT发生风险提供参考。

关键词: 先天性心脏病, 中心静脉导管, 静脉血栓形成, 风险, 预测模型, 儿科护理学

JIANG Weihong, JIN Chendi, LI Shuaini, YANG Shanfeng, YAN Chuanchuan, ZHU Jihua. Construction and validation of a risk prediction model for central venous catheter-associated deep venous thromboses in children with congenital heart disease after surgery[J]. Chinese Journal of Nursing, 2022, 57(18): 2217-2224.

蒋伟红, 金陈娣, 李帅妮, 杨山凤, 严川川, 诸纪华. 先天性心脏病术后患儿中心静脉导管相关深静脉血栓风险预测模型的构建及验证[J]. 中华护理杂志, 2022, 57(18): 2217-2224.

Figures/Tables 5

Table 1 The result of single factor analysis of central venous catheter-associated deep venous thromboses in children with congenital heart disease after surgery

Table 2 Logistic regression analysis of central venous catheter-associated deep venous thrombosis in children with congenital heart disease after surgery

Figure 1 A nomogram model for predicting central venous catheter-associated deep venous thrombosis in children with congenital heart disease after surgery

Figure 2 Receiver operating characteristic curve of the risk prediction model for central venous catheter-associa-ted deep venous thrombosis in the modeling group

Figure 3 Receiver operating characteristic curve of the risk prediction model for central venous catheter-asso-ciated deep venous thrombosis in the validation group

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