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    基于血液透析的尿毒症病人临床特征构建随机森林模型筛选影响焦虑情绪发生的危险因素

    Constructing a random forest model based on clinical characteristics of uremic patients treated with hemodialysis to screen the risk factors affecting anxiety

      摘要
    • 摘要:
      目的： 构建基于尿毒症病人临床特征的随机森林预测模型，并评估其预测规律维持性血液透析（MHD）病人发生焦虑情绪的价值。
      方法： 选取2023年2月至2024年8月亳州市人民医院血液净化中心收治的162例MHD治疗的尿毒症病人作为研究对象，根据焦虑抑郁量表（HADS-14）评分将病人分为焦虑组41例与无焦虑组121例。比较2组基线资料及临床特征；采用二元logistic回归分析病人发生焦虑情绪的影响因素，并应用R（R4.1.0）软件包及randomForest程序包构建随机森林模型。绘制受试者工作曲线（ROC）分析随机森林模型预测经MHD治疗后尿毒症病人发生焦虑情绪的危险因素。
      结果： 尿毒症病人经MHD治疗后HADS-A评分为（5.46 ± 2.68）分；焦虑组体质量指数（BMI）＜18.50 kg/cm2、皮肤瘙痒、血红蛋白（Hb） ＜ 90 g/L、匹兹堡睡眠质量指数（PSQI）评分≥11分占比高于无焦虑组（P ＜ 0.01）；多因素logistic回归分析结果显示，BMI ＜ 18.50 kg/cm2、皮肤瘙痒、Hb ＜ 90 g/L、PSQI评分≥11分是尿毒症病人经MHD治疗后发生焦虑情绪的危险因素（OR = 3.654、3.147、5.287和5.343，P ＜ 0.01）；采用%IncMse打分并进行特征重要性排序，其中重要性前三分别为Hb、PSQI评分及BMI，%IncMse × 10–2分别为23.781%、22.881%、22.084%，随机森林模型P = 0.01，R2 = 0.220；以BMI、皮肤瘙痒、Hb、PSQI评分建立随机森林模型预测尿毒症病人经MHD治疗后发生焦虑情绪的AUC为0.757，敏感度为0.911，特异度为0.672，约登指数为0.583，具有较好的预测效能。
      结论： BMI、皮肤瘙痒、Hb、PSQI评分是尿毒症病人经MHD治疗后发生焦虑情绪的重要影响因素，基于上述因素构建的决策树模型具有较高的预测价值。

       

      Abstract:
      Objective To construct a random forest prediction model based on clinical features of uremic patients, and assess its value in predicting anxiety among maintenance hemodialysis (MHD) patients.
      Methods A total of 162 uremic patients treated with MHD in the Blood Purification Center of Bozhou People's Hospital from February 2023 to August 2024 were selected as the research subjects. According to the score of the Anxiety and Depression Scale (HADS-14), the patients were divided into the anxiety group (41 cases) and the non-anxiety group (121 cases). The baseline data and clinical characteristics were compared between two groups; Binary logistic regression was used to analyze the influencing factors of anxiety in patients, and the R (R4.1.0) software package and randomForest program package were applied to construct the random forest model. The receiver operating characteristic curve (ROC) was drawn to analyze the risk factors of the random forest model for predicting anxiety in uremic patients after MHD treatment.
      Results The HADS-A score of uremic patients after MHD treatment was (5.46 ± 2.68) points. The proportions of body mass index (BMI) ＜ 18.50 kg/cm2, skin pruritus, hemoglobin (Hb) ＜ 90 g/L, and Pittsburgh Sleep Quality Index (PSQI) score ≥11 in the anxiety group were higher than those in non-anxiety group (P ＜ 0.01). The results of multivariate logistic regression analysis showed that the BMI ＜ 18.50 kg/cm2, pruritus, Hb ＜ 90 g/L, and PSQI score ≥11 points were the risk factors of anxiety in uremic patients after MHD treatment (OR = 3.654, 3.147, 5.287, and 5.343) (P ＜ 0.01). The %IncMse scoring was adopted,and the feature importance was ranked. Among them, the top three importance scores were Hb, PSQI score and BMI, respectively. The %IncMse × 10–2 were 23.781%, 22.881% and 22.084% respectively. The random forest model were P = 0.01 and R2 = 0.220. The AUC of the random forest model established based on BMI, pruritus, Hb and PSQI score for predicting anxiety in uremic patients after MHD treatment was 0.757, the sensitivity was 0.911, the specificity was 0.672, and the Youden index was 0.583, and which showed good predictive efficacy.
      Conclusions The BMI, skin itching, Hb, and PSQI scores are the important influencing factors of anxiety in patients with uremia after MHD treatment. The decision tree model constructed based on these factors has high predictive value.

       

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