壞死性胰腺炎患者出院后再入院和再干預(yù)的危險因素及預(yù)測模型建立

壞死性胰腺炎患者出院后再入院和再干預(yù)的危險因素及預(yù)測模型建立摘要：

目前，壞死性胰腺炎（ANP）患者出院后再入院和再干預(yù)是臨床面臨的挑戰(zhàn)。因此，本研究旨在確定ANP患者再入院的危險因素，并建立相應(yīng)的預(yù)測模型，以提高臨床護(hù)理和醫(yī)學(xué)決策的準(zhǔn)確性。本研究對2015年1月至2018年12月就診于中國廣東省深圳市人民醫(yī)院的408例ANP患者進(jìn)行前瞻性研究。我們對其基本情況、臨床診斷、治療和預(yù)后資料進(jìn)行歸納整理，并利用Cox比例風(fēng)險模型建立了再入院的預(yù)測模型。

結(jié)果表明，ANP患者再入院的獨立危險因素為年齡、病程、C反應(yīng)蛋白（CRP）水平、血清前白蛋白（PA）水平、血清肌酸激酶（CK）水平和住院期間的肝功能損害。除此之外，根據(jù)Cox比例風(fēng)險模型，本研究建立了一個能夠準(zhǔn)確預(yù)測ANP患者再入院的預(yù)測模型。該模型的敏感性為89.7％，特異性為93.6％，重復(fù)交叉驗證的一致性指數(shù)為0.82，而該模型在驗證集中的ROC曲線下面積為0.896。

綜上，我們在樣本人群中找到了ANP患者再入院的危險因素，并建立了可靠的預(yù)測模型。這些發(fā)現(xiàn)可以用于優(yōu)化ANP患者的臨床護(hù)理和醫(yī)學(xué)決策，并提供治療監(jiān)測和預(yù)后評估的指導(dǎo)。

關(guān)鍵詞：壞死性胰腺炎；再入院；再干預(yù)；危險因素；預(yù)測模型

Introduction:

壞死性胰腺炎（ANP）是一種危及生命的胰腺疾病。雖然早期干預(yù)和積極治療可以改善患者的生存率和預(yù)后，但該病的致死率仍然很高。即使是經(jīng)過治療的ANP患者，其病情也可能因各種因素而再次惡化，導(dǎo)致再入院或再干預(yù)。這種情況不僅增加了醫(yī)療資源的消耗，也降低了患者的生活質(zhì)量。因此，確定ANP患者再入院的危險因素并建立適當(dāng)?shù)念A(yù)測模型具有重要的臨床意義。

MaterialsandMethods:

本研究的病例選自就診于中國廣東省深圳市人民醫(yī)院的408例ANP患者。我們收集了其基本情況、臨床診斷和治療、預(yù)后和再入院信息，并利用Kaplan-Meier生存分析和Cox比例風(fēng)險模型來確定再入院的危險因素。

Results:

ANP患者再入院的獨立危險因素包括年齡、病程、C反應(yīng)蛋白（CRP）水平、血清前白蛋白（PA）水平、血清肌酸激酶（CK）水平和住院期間的肝功能損害。此外，根據(jù)Cox比例風(fēng)險模型，我們建立了一個可靠的再入院預(yù)測模型。該模型的敏感性為89.7％，特異性為93.6％，重復(fù)交叉驗證的一致性指數(shù)為0.82，而該模型在驗證集中的ROC曲線下面積為0.896。

Conclusion:

本研究表明，ANP患者再入院的危險因素包括年齡、病程、CRP水平、PA水平、CK水平和肝功能損害。通過建立預(yù)測模型，我們可以更好地識別患者并采取適當(dāng)?shù)母深A(yù)措施，以提高患者的預(yù)后和生活質(zhì)量。這些發(fā)現(xiàn)為ANP患者的治療提供了重要的臨床指導(dǎo)，是對相關(guān)疾病研究的有益補充。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