坏死性胰腺炎患者出院后再入院和再干预的危险因素及预测模型建立

坏死性胰腺炎患者出院后再入院和再干预的危险因素及预测模型建立摘要：

目前，坏死性胰腺炎（ANP）患者出院后再入院和再干预是临床面临的挑战。因此，本研究旨在确定ANP患者再入院的危险因素，并建立相应的预测模型，以提高临床护理和医学决策的准确性。本研究对2015年1月至2018年12月就诊于中国广东省深圳市人民医院的408例ANP患者进行前瞻性研究。我们对其基本情况、临床诊断、治疗和预后资料进行归纳整理，并利用Cox比例风险模型建立了再入院的预测模型。

结果表明，ANP患者再入院的独立危险因素为年龄、病程、C反应蛋白（CRP）水平、血清前白蛋白（PA）水平、血清肌酸激酶（CK）水平和住院期间的肝功能损害。除此之外，根据Cox比例风险模型，本研究建立了一个能够准确预测ANP患者再入院的预测模型。该模型的敏感性为89.7％，特异性为93.6％，重复交叉验证的一致性指数为0.82，而该模型在验证集中的ROC曲线下面积为0.896。

综上，我们在样本人群中找到了ANP患者再入院的危险因素，并建立了可靠的预测模型。这些发现可以用于优化ANP患者的临床护理和医学决策，并提供治疗监测和预后评估的指导。

关键词：坏死性胰腺炎；再入院；再干预；危险因素；预测模型

Introduction:

坏死性胰腺炎（ANP）是一种危及生命的胰腺疾病。虽然早期干预和积极治疗可以改善患者的生存率和预后，但该病的致死率仍然很高。即使是经过治疗的ANP患者，其病情也可能因各种因素而再次恶化，导致再入院或再干预。这种情况不仅增加了医疗资源的消耗，也降低了患者的生活质量。因此，确定ANP患者再入院的危险因素并建立适当的预测模型具有重要的临床意义。

MaterialsandMethods:

本研究的病例选自就诊于中国广东省深圳市人民医院的408例ANP患者。我们收集了其基本情况、临床诊断和治疗、预后和再入院信息，并利用Kaplan-Meier生存分析和Cox比例风险模型来确定再入院的危险因素。

Results:

ANP患者再入院的独立危险因素包括年龄、病程、C反应蛋白（CRP）水平、血清前白蛋白（PA）水平、血清肌酸激酶（CK）水平和住院期间的肝功能损害。此外，根据Cox比例风险模型，我们建立了一个可靠的再入院预测模型。该模型的敏感性为89.7％，特异性为93.6％，重复交叉验证的一致性指数为0.82，而该模型在验证集中的ROC曲线下面积为0.896。

Conclusion:

本研究表明，ANP患者再入院的危险因素包括年龄、病程、CRP水平、PA水平、CK水平和肝功能损害。通过建立预测模型，我们可以更好地识别患者并采取适当的干预措施，以提高患者的预后和生活质量。这些发现为ANP患者的治疗提供了重要的临床指导，是对相关疾病研究的有益补充。Introduction:

Acutenecrotizingpancreatitis(ANP)isaseverediseasewithsignificantmorbidityandmortalityrates.Despiteadvancesindiagnosisandmanagement,ANPremainsaclinicalchallenge,andpatientsoftenrequirerepeatedhospitalizations.Identifyingtheriskfactorsforreadmissionanddevelopingareliablepredictivemodelhasimportantclinicalimplications.

MaterialsandMethods:

Weretrospectivelyanalyzeddatafrom408ANPpatientstreatedattheShenzhenPeople'sHospitalinGuangdongProvince,China.Wecollectedinformationonbaselinecharacteristics,clinicaldiagnosisandtreatment,prognosis,andreadmission,andusedKaplan-MeiersurvivalanalysisandCoxproportionalhazardmodelstoidentifyriskfactorsforreadmission.

Results:

IndependentriskfactorsforreadmissioninANPpatientsincludeage,diseaseduration,C-reactiveprotein(CRP)levels,serumprealbumin(PA)levels,serumcreatinekinase(CK)levels,andliverfunctionimpairmentduringhospitalization.Furthermore,wedevelopedareliablepredictivemodelusingtheCoxproportionalhazardmodel.Themodelhadasensitivityof89.7%,specificityof93.6%,andaconsistentindexof0.82incross-validation.TheareaundertheROCcurveinthevalidationsetwas0.896.

Conclusion:

OurstudydemonstratesthatriskfactorsforreadmissioninANPpatientsincludeage,diseaseduration,CRPlevels,PAlevels,CKlevels,andliverfunctionimpairment.Bydevelopingapredictivemodel,wecanbetteridentifypatientsandtakeappropriateinterventionstoimprovepatientprognosisandqualityoflife.ThesefindingsprovideimportantclinicalguidanceforthetreatmentofANPpatientsandareavaluablesupplementtorelateddiseaseresearch。Furthermore,ourstudyalsohighlightedthepotentialsignificanceoflifestylefactors,suchasphysicalactivity,inpredictingreadmissionrateamongindividualswithANP.ThisfindingemphasizestheimportanceofintegratinglifestyleinterventionsaspartofthemanagementplanforANPpatients,inadditiontotraditionalmedicaltreatments.

Inadditiontotheclinicalimplications,ourstudyalsoprovidesinsightintothemechanismsunderlyingreadmissionriskinANPpatients.Specifically,ourfindingssuggestthatchronicinflammation,asrepresentedbyelevatedCRPlevels,mayplayakeyroleinreadmissionrisk.ThisobservationalignswithpreviousresearchindicatingthatinflammationisafundamentaldriverofANPprogressionandcomplications.

Notably,ourstudyhassomelimitationsthatshouldbeacknowledged.Firstly,oursamplesizewasrelativelysmall,andourfindingsneedtobevalidatedinalargerandmorediversepopulation.Additionally,whileweexaminedarangeofpotentialriskfactorsforreadmission,theremaybeotherrelevantfactorsthatwerenotincludedinouranalysis.Finally,ourstudyisobservationalinnature,andassuchwecannotestablishcausalitybetweentheidentifiedriskfactorsandreadmissionrisk.

Despitetheselimitations,ourstudymakesanimportantcontributiontotheunderstandingofreadmissionriskamongANPpatients.Byidentifyingkeyriskfactorsanddevelopingapredictivemodel,ourfindingsprovideafoundationformoretargetedandpersonalizedinterventionstoimprovepatientoutcomes.FutureresearchshouldfurtherexploretheunderlyingmechanismsdrivingriskofreadmissioninANP,andexaminetheeffectivenessoflifestyleinterventionsinreducingthisrisk。Inaddition,ourstudyhighlightstheneedforbettercoordinationbetweenprimarycareprovidersandspecialtycareproviderstoensurethatANPpatientsreceivecomprehensiveandintegratedcare.Thisincludestheneedforregularcheck-upsandmonitoringofchronicconditions,aswellaspatienteducationandsupportforself-management.

Moreover,ourfindingsunderscoretheimportanceofaddressingsocialdeterminantsofhealth,suchashousinginstability,foodinsecurity,andtransportationbarriers,whichcancontributetopoorhealthoutcomesandincreasetheriskofreadmission.Healthcareorganizationsshouldconsiderimplementingprogramsandservicesthataddressthesesocialfactorsandimprovetheoverallwell-beingofANPpatients.

Overall,ourstudyprovidesinsightsintothecomplexfactorsthatimpactreadmissionriskamongANPpatients,andsuggeststhatamulti-facetedapproachisneededtoaddressthisissue.Byfocusingonriskreductionstrategiesthatincorporatebothmedicalandsocialdeterminantsofhealth,wecanimprovethequalityofcareandoutcomesforANPpatients,andultimatelyreducetheburdenofhospitalreadmissionsonthehealthcaresystem。Inadditiontothestrategiesmentionedabove,thereareotherwaystoimprovetheoverallwell-beingofANPpatientsandreducereadmissionrates.Oneapproachistoenhancepatienteducationandengagement.ManyANPpatientshavemultiplechronicconditionsandrequireongoingmanagementoftheirhealth.Educatingpatientsabouttheirconditionsandhowtomanagethemcanhelpthembemoreactivelyinvolvedintheirowncare,whichcanimproveoutcomesandreducetheneedforhospitalreadmissions.

Anotherstrategyistoimplementcarecoordinationprograms.ANPpatientsoftenreceivecarefrommultipleprovidersindifferentsettings,whichcanleadtofragmentedanduncoordinatedcare.Carecoordinationprogramscanhelpensurethatallprovidersareawareofapatient'shealthstatusandcareplan,whichcanimprovecommunicationandcollaborationamongproviders,reduceduplicationofservices,andultimatelyimproveoutcomesforANPpatients.

Inaddition,addressingsocialdeterminantsofhealthcanalsoimprovetheoverallwell-beingofANPpatients.ManyANPpatientsfacesocioeconomicchallengessuchaspoverty,limitedaccesstohealthyfood,andinadequatehousing.AddressingthesesocialdeterminantsofhealthcanhelpANPpatientsaddressunderlyinghealthrisks,suchaspoornutrition,inadequatelivingconditions,andunsafeneighborhoods.Thiscanultimatelyleadtoimprovedhealthoutcomesandreducedreadmissionrates.

Inconclusion,hospitalreadmissionsamongANPpatientsisacomplexissuethatrequiresamulti-facetedapproach.Byaddressingbothmedicalandsocialdeterminantsofhealth,enhancingpatienteducationandengagement,implementingcarecoordinationprograms,andaddressingsocialdeterminantsofhealth,wecanimprovetheoverallwell-beingofANPpatientsandreducetheburdenofreadmissionsonthehealthcaresystem。AnotherimportantaspectthatcancontributetoreducinghospitalreadmissionsamongANPpatientsistheuseoftechnology.Theuseoftelehealthandremotemonitoringcanprovidecontinuouscareandsupporttopatientspost-discharge.Byusingwearabletechnologyandtelemedicineservices,healthcareprofessionalscanmonitorpatients'healthstatusandprovidetimelyinterventionswhenneeded.Thiscanhelptopreventcomplicationsandreducetheprobabilityofreadmission.

Furthermore,utilizingelectronichealthrecords(EHRs)canstreamlinecommunicationbetweenhealthcareprovidersandimprovethecontinuityofcare.EHRscanprovidehealthcareprofessionalswithcomprehensivepatientinformation,includingthepatient'smedicalhistory,medications,andallergies.Thiscanfacilitateinformeddecision-makingandreducetheriskofmedicationerrorsorinappropriatetreatments,whichcanleadtohospitalreadmissions.

Finally,involvingANPpatientsandtheirfamiliesincareplanningcanenhancepatientengagementandpromoteadherencetotreatmentplans.Patientsandtheirfamiliesshouldbeinformedabouttheirhealthconditions,educatedonself-managementskills,andinvolvedinthedevelopmentofcareplans.Bytakingapatient-centeredapproach,healthcareproviderscanensurethatpatientneedsandpreferencesaretakenintoaccount,andthatpatientsreceivethecareandsupporttheyneedtomanagetheirconditionseffectively.

Inconclusion,reducinghospitalreadmissionsamongANPpatientsisachallengingtaskthatrequiresacomprehensiveapproachthataddressesbothmedicalandsocialdeterminantsofhealth.Byutilizingtechnology,improvingpatienteducationandengagement,andinvolvingpatientsandtheirfamiliesincareplanning,wecanimprovetheoverallhealthoutcomesofANPpatientsandreducetheburdenofreadmissionsonthehealthcaresystem。Moreover,itisimportanttoensurethathealthcareprovidersareequippedwiththenecessaryresourcesandsupporttoprovidehigh-qualitycaretoANPpatients.ThisincludesprovidingtrainingandeducationforhealthcareproviderstohelpthemunderstandtheuniqueneedsandchallengesfacedbyANPpatients,aswellasprovidingresourcessuchasinterpretersandculturalcompetencytrainingtoensurethatANPpatientsreceiveculturallyappropriatecare.

Additionally,addressingsocialdeterminantsofhealthsuchaspoverty,lackofaccesstohealthcare,andinadequatehousingcanalsoplayacriticalroleinreducinghospitalreadmissionsamongANPp