Establishment and evaluation of a nomogram prediction model for coagulation in the extracorporeal circuit in elderly hemodialysis patients / 中华老年医学杂志

ABSTRACT

Objective:To establish a predictive model for coagulation in the extracorporeal circuit in elderly hemodialysis(HD)patients.Methods:The retrospective case-control study included 196 elderly patients with chronic renal failure receiving 4-h hemodialysis for the first time at the blood purification center of our hospital between March 1, 2019 and January 30, 2022.All enrolled patients were treated with heparin or related drugs for anticoagulation(including unfractionated heparin and low molecular weight heparin), with 14 cases(7.1%)in the coagulation group with a coagulation grade ≥1.There were 182 cases(92.9%)in the non-coagulation group.Demographic data, vital signs in a sitting position and the resting state before dialysis and laboratory tests before dialysis were collected.After the prediction model was developed, it was validated in elderly patients with chronic renal failure aged ≥60 years receiving 4-hour hemodialysis for the first time at our hospital between February 1, 2022 and February 1, 2023.Results:There were significant differences in heart rate[(82.6±12.3)times/min vs.(74.4±11.1)times/min]and total cholesterol[(4.3±1.2)mmol/L vs.(3.2±1.2)mmol/L]between the coagulation group and the non-coagulation group( t=2.231, 2.012, P<0.05).Multivariate logistic analysis showed that the heart rate( OR=0.930, 95% CI: 0.871-0.993, P<0.05)and cholesterol( OR=0.623, 95% CI: 0.391-0.992, P<0.05)had an effect on blood coagulation in cardiopulmonary bypass.The area under the curve(AUC)for predicting cardiopulmonary bypass clotting by heart rate was 0.639(the optimal cutoff value was 71 beats/min), the AUC for predicting clotting by total cholesterol was 0.708(the optimal cutoff value: 4.275 mmol/L), and the prediction using the combination of heart rate and total cholesterol was more effective(AUC=0.735).The model was verified in 98 patients with good results(AUC=0.895). Conclusions:The initial coagulation risk of the extracorporeal circuit in elderly patients undergoing initial HD can be preliminarily estimated based on the nomogram.