Risk Factor Analysis And Risk Prediction Model Construction For Pressure Injury In Patients Ventilated In Prone Position

Study objectivesTo investigate the risk factors associated with pressure injury in patients ventilated in prone position,and construct a nomogram model of the risk of pressure injury in patients ventilated in prone position was,which can help clinical staff to identify the high-risk patients of pressure injury during prone ventilation early,take timely and effective preventive measures to reduce the risk of pressure injury in patients ventilated in prone position.Study methodsIn this study,patients with prone ventilation from January 2012 to December 2021 in a tertiary care hospital in Lanzhou City were used as the modeling group,and patients with prone ventilation from January 2022 to March 2023 were used as the external validation group.The data of the modeling group were collected using the self-designed Risk Factor Questionnaire for Pressure Injury in Patients Ventilated in Prone Position to collect relevant clinical data of patients during the implementation of prone ventilation.A total of 310 patients with prone ventilation were included in the modeling group,and candidate variables for entry into binary logistic regression were identified by univariate analysis and covariate diagnosis using SPSS 26.0.Binary logistic regression analysis was performed using the forward LR method to determine the risk factors for pressure injury in patients ventilated in the prone position.Based on the results of the regression analysis,the R software were used to construct a column line graph model for predicting pressure injury in patients ventilated in prone position.And the column line graph model was validated internally(modeling group)and externally(validation group),and the model prediction efficacy was evaluated by observing the area under the ROC curve,calibration curve and clinical decision curve.Study results1.A total of 310 patients with prone ventilation were included in the modeling group of this study,with a mean patient age of 57.37 ± 15.58 years.Among them,189cases(61.1%)were male and 121 cases(38.9%)were female.A total of 64 patients with a mean age of 59.18±16.71 years were included in the external validation group for prone ventilation.There were 43 cases(67.2%)of males and 21 cases(32.8%)of females.2.Univariate analysis and Collinearity diagnosis showed that age,ICU stay days,total protein level,serum albumin level,hemoglobin level,D-dimer,glucose,Lactic acid,arterial oxygen saturation,temperature,APACHE-II score,Braden score,SOFA score,total duration of prone position ventilation,single cycle duration of prone position ventilation,RASS score,edema,shock,sepsis and application of Vasoconstrictor were 20 factors as candidate variables(P<0.05)and included in binary logistic regression analysis.Regression analysis showed that application of vasoconstrictors,edema,serum albumin level,hemoglobin level,total duration of prone ventilation,single cycle duration of prone ventilation,and Braden score were risk factors of pressure injury in patients ventilated in the prone position.Based on this,a nomogram model of the risk of pressure injury in patients ventilated in prone position was constructed.3.The AUC of the nomogram model was 0.891(95% CI: 0.853-0.930)and the model calibration AUC obtained from internal validation was 0.892(95% CI: 0.862-0.895),indicating that the model had better discrimination.The calibration curve showed that the model calibration curve and the standard curve were less biased(H-L test,p=0.347),indicating that the nomogram model had better calibration degree.The clinical decision curves showed that the nomogram model has good clinical value.Substituting the validation set data into the model as external validation,the results showed that the area under the AUC of the model validation group was 0.849(95% CI:0.718-0.980),indicating good model discrimination.The calibration curve showed that the model calibration curve and the standard curve were less biased(H-L test,P=0.639).The clinical decision curves indicated that the model had good clinical value.Study conclusionsIn this study,application of vasoconstrictors,edema,serum albumin level,hemoglobin level,total duration of prone ventilation,single duration of prone ventilation and Braden score were high risk factors for pressure injury in patients ventilated in prone position.According to these risk factors,appropriate preventive measures should be applied.The nomogram model of pressure injury in patients ventilated in prone position constructed in this study had better discrimination,calibration and clinical value,and also has good external predictive performance with good generalization.It is convenient for clinical staff to identify people at high risk of pressure injury during prone ventilation,timely and effective preventive measures to reduce the risk of pressure injury in patients ventilated in prone position.