Risk Factors Analysis And Risk Model Construction For Prognosis Of Uremia Dialysis Patients Complicated With Intracerebral Hemorrhage

BackgroundUremia refers to all kinds of primary or secondary kidney disease caused by the loss of renal function and metabolic waste cannot be ruled out in vitro,and appear a series of clinical symptoms of chronic diseases.Along with the social medical security system gradually improved,and the progress of the dialysis technology,patients with uremia hemodialysis group increased,quality of life improved,also gradually extend survival time.Uremia patients with cerebrovascular accident probability of a normal population increased significantly,are 3 ~ 10 times,and the prognosis is worse.So analysis maintenance dialysis merge bleeding in the brain(intracerebral hemorrhage,for example)potential influence factors of prognosis and timely intervention,to optimize maintenance dialysis combined example patient treatment,improve the treatment effect,reduce maintenance dialysis patients death causes damage factors have positive clinical significance.ObjectiveUremia line maintenance dialysis by retrospective study to investigate the effects and the prognosis of patients with cerebral hemorrhage risk factors,further risk prediction model was constructed.MethodsTake a retrospective analysis of research methods,this study selected in January 2014-December 2018 in the center of the nanyang municipal hospital clinic of uremia line maintenance dialysis and 54 patients with ICH were given hemodialysis or peritonealdialysis and intracraninal pressure,control blood pressure,stop bleeding,symptomatic treatment,such as nutrition nerve and assess Rankin score were followed up for 6 months,according to the Rankin score,survival situation into good prognosis groups(Rankin score2 points or less)and poor prognosis group(Rankin score 3 to 6 points and was discharged on hospital and/or death within 30 d).Comparison between groups of various clinical data and analysis of the prognosis of patients with uremia line maintenance dialysis and ICH risk factors,according to the risk factor weight to build further risk model.Results(1)Overall maintenance dialysis and ICH patients clinical data results show that age,diabetes rates on admission,fasting glucose,amount of bleeding in the brain,hemoglobin,albumin levels and mean arterial pressure control related to the prognosis of patients with significant(p < 0.05),and other factors(group between the sex ratio,ratio,ratio of cardiovascular disease,cerebral hemorrhage broken into the ventricle hemorrhage parts and square type,age of dialysis,dialysis ratio of platelet count,platelet and lymphocyte count,prothrombin time,activated partial prothrombin time,serum creatinine,blood urea nitrogen)compare the differences had no statistical significance(p > 0.05);The prognosis of patients with and without correlation.(2)Logistic regression analysis showed that age,mean arterial pressure,amount of bleeding in the brain,albumin is on maintenance dialysis and independent risk factors for the prognosis of patients with cerebral hemorrhage(P <0.05).Based on logistic regression analysis,can get the regression equation: predict = P-29.923-0.202 X1 + 0.050 X2 + 0.278 X3 0.106 X4,X1: age,X2,mean arterial pressure,and the X3: cerebral hemorrhage quantity,X4: albumin.(3)The ROC curve of maximum Youden index is 0.816,the cutoff value is 0.764,the sensitivity was 87.3%,specificity of98.7%,the area under the curve is 0.952.The model fitting validity is good,high predictive value.Conclusion1.Age,diabetes rates on admission,fasting glucose,amount of bleeding in the brain,hemoglobin,albumin levels and mean arterial pressure control is associated with the prognosis of patients with significant.2.Age,mean arterial pressure,amount of bleeding in the brain,albumin is on maintenance dialysis and independent risk factors for the prognosis of patients with cerebral hemorrhage.3.This study built prediction model has better assessment of the effectiveness,has certain clinical application value.