Analysis of risk factors and construction of prediction model for five-year mortality of traumatic cervical spinal cord injury
Jiang Shuai1, Wu Shunjie2, Wu Xiaodong1, Huo Weiling1, Hong Xin2, Cheng Jian1
1Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou 221009, China; 2Department of Spine Surgery, the Affiliated Zhongda Hospital of Southeast University, Nanjing 210009, China
Abstract：Objective This study aims to explore the clinical risk factors of the five-year mortality of traumatic cervical spinal cord injury (TCSCI) and the predictive efficacy of the prediction model. Methods In this retrospective cohort study, 2 540 patients were selected from the National Spinal Cord Injury Database from January 2010 to December 2017, including 2 030 males and 510 females with age in the range of 15-89 years. The 2 540 patients were randomly divided into the development cohort (1 927 patients) and the validation cohort (613 patients) in a 3∶1 ratio. The development cohort was used for analyzing of risk factors and establishing a five-year mortality prediction model. The validation cohort was used for the internal validation of the model. According to whether the patients in the development cohort died five years after TCSCI, they were divided into death group (373 patients) and survival group (1 554 patients). Outcome measures: (1) The clinicopathological features of patients with TCSCI in the development cohort and the validation cohort were compared. (2) The clinical baseline data of the two groups of patients with TCSCI in the development cohort, as well as observation indicators such as whether they were readmitted to hospital due to respiratory or urinary diseases after discharge and whether patients should go to a medical institution for further treatment after discharge, were analyzed by univariate analysis and multivariate logistic regression analysis to determine the independent risk factors for the five-year mortality of TCSCI. A nomogram model was constructed to predict the five-year mortality according to the risk factors. (3) In the validation cohort, the receiver operating characteristic (ROC) curve, the calibration curve, and the decision curve were used to evaluate the predictive performance of the nomogram model. Results (1) No significant difference existed between the clinicopathological features of patients with TCSCI in the development cohort and the validation cohort in gender, age, combined injury and degree of spinal cord injury (all P values >0.05). (2) Univariate analysis of the development cohort showed age, injury segment, American Spinal Injury Association (ASIA) spinal cord injury grade, vertebral fracture, surgery, mechanical ventilation during hospitalization, readmission to hospital for respiratory or urinary diseases after discharge, and patients should go to a medical institution for further treatment after discharge were the influencing factors for the five-year mortality of TCSCI (all P values <0.05). Multivariate logistic regression analysis showed age, ASIA spinal cord injury grade, mechanical ventilation during hospitalization, readmission for respiratory or urinary diseases after discharge, and patients should go to a medical institution for further treatment after discharge were independent risk factors for the five-year mortality of TCSCI (all P values <0.05). A nomogram prediction model was constructed according to the risk factors, and an internal verification of the nomogram model was conducted on the validation cohort. The ROC curve showed the area under the curve was 0.841, the 95% confidence interval was 0.817-0.864, the threshold was 0.219, the sensitivity was 82.5%, the specificity was 70.0%, and the diagnostic performance of the nomogram model was satisfactory. The calibration curves revealed the predicted and actual five-year mortality probabilities were fitted well. The decision curve analysis demonstrated the clinical value of this nomogram. The calibration curve showed the nomogram prediction model exhibited good consistency between the predicted mortality rate and the actual mortality rate. The analysis of decision curve showed the nomogram prediction model had a high clinical application value. Conclusion The results show advanced age, high ASIA spinal cord injury grade, mechanical ventilation during hospitalization, readmission due to respiratory or urinary system diseases, and patients should go to a medical institution for further treatment after discharge are independent risk factors for the five-year mortality of TCSCI. The nomogram prediction model constructed according to the risk factors displays good prediction performance and which can provide a reference for predicting the five-year mortality of TCSCI.
蒋帅, 吴舜杰, 吴晓东, 霍维玲, 洪鑫, 程建. 创伤性颈脊髓损伤5年死亡率的危险因素分析及预测模型的构建[J]. 中华解剖与临床杂志, 2024, 29(1): 36-42.
Jiang Shuai, Wu Shunjie, Wu Xiaodong, Huo Weiling, Hong Xin, Cheng Jian. Analysis of risk factors and construction of prediction model for five-year mortality of traumatic cervical spinal cord injury. Chinese Journal of Anatomy and Clinics, 2024, 29(1): 36-42.
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2024, Vol. 29 
