基于总胆红素和白蛋白比值的新生儿急性胆红素脑病预测模型

Prediction model of acute neonatal bilirubin encephalopathy based on ratio of total bilirubin to albumin

摘要

目的 构建和验证结合总胆红素和白蛋白比值(B/A)的预测模型,以预测高胆红素血症新生儿发生急性胆红素脑病(ABE)的风险。方法 选取2015年1月至2022年12月期间在黄河三门峡医院住院的535例高胆红素血症新生儿为研究对象,根据有无ABE的发生,将患儿分为ABE新生儿(n=96)和无ABE新生儿(n=439)两组.比较两组新生儿人口统计学特征、病理信息及入院检查结果等,受试者工作特征(ROC)曲线分析各变量预测ABE发生的能力.单因素和多因素Logistic回归分析评估急性胆红素脑病的影响因素,并进一步构建列线图模型.采用ROC曲线、校正曲线评估模型的效能,采用临床决策曲线(DCA)评估模型的临床实用价值。结果 多因素Logistic回归分析显示,母龄、白细胞计数、总胆红素、B/A、高敏C反应蛋白(CRP)是新生儿胆红素脑病的独立危险因素(aOR值分别为2.548、3.640、1.236、6.289、1.680,P<0.05),白蛋白是新生儿胆红素脑病的独立保护因素(aOR=0.456,P<0.05);进一步构建了基于母亲年龄、白细胞计数、B/A、CRP共4个变量的ABE发生风险的列线图,模型C指数为0.879,曲线下面积(AUC)为0.899(95%CI:0.869~0.930),且校准曲线显示模型具有较好的辨别能力;DCA显示模型在实际临床工作中使得患者有更多获益。结论 B/A是高胆红素血症新生儿发生ABE的独立影响因素和有效预测指标,构建的包含B/A的列线图,具有良好预测能力.

Abstract

Objective To construct and validate a prediction model based on ratio of total bilirubin to albumin (B/A) to predict risk of acute bilirubin encephalopathy (ABE) in neonates with hyperbilirubinemia. Methods A total of 535 neonates with hyperbilirubinemia who hospitalized in Yellow River Sanmenxia Hospital from January 2015 to December 2022 were selected as research subjects. According to whether ABE occurred, the neonates were divided into two groups: ABE neonate group (n=96) and ABE-free neonate group (n=439). Demographic characteristics, pathological information and admission examination results of the neonates were compared between the two groups. Receiver operating characteristic (ROC) curve was use to analyze predictive value of each variable for occurrence of ABE. Univariate and multivariate Logistic regression analyses were used to evaluate influencing factors of ABE, and then a nomogram model was constructed. ROC curve and calibration curve were used to evaluate efficacy of the model, and decision curve analysis (DCA) was used to evaluate clinical practical value of the model. Results Multivariate Logistic regression analysis showed that maternal age, neonate's white blood cell count (WBC), total bilirubin, B/A ratio, hypersensitive C-reactive protein (hsCRP) were independent risk factors for occurrence of ABE [adjusted odds ratio (aOR) values were 2.548, 3.640, 1.236, 6.289 and 1.680 respectively, all P<0.05], and albumin was a protective factor for occurrence of ABE (aOR=0.456, P<0.05). The nomogram of risk of ABE occurrence based on a total of 4 variables including maternal age, neonate's WBC, B/A ratio and hsCRP was constructed. The C-index of the model was 0.879, the AUC was 0.899 (95%CI: 0.869-0.930), and the calibration curve showed that the model had good discrimination ability. The DCA showed that the model benefited to the neonates more in actual clinical work. Conclusion B/A ratio is an independent factor and an effective predictor of ABE in neonates with hyperbilirubinemia.

关键词

急性胆红素脑病 / 危险因素 / 列线图 / 总胆红素与白蛋白比值

Key words

acute bilirubin encephalopathy / risk factor / nomogram / total bilirubin to albumin ratio

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