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A nomogram based on InLDH and InNLR for predicting disseminated intravascular coagulation in patients with heat
Lulu Wan1, Gan Lin2,3, Jiale Yang2,4
1Department of Intensive Care Unit, Longgang Central Hospital of Shenzhen, Shenzhen, China.
Insights
Early detection of disseminated intravascular coagulation (DIC) in heat stroke (HS) is crucial. A new predictive model using lactate dehydrogenase (LDH) and neutrophil-lymphocyte ratio (NLR) effectively identifies patients at risk for DIC, enabling timely intervention.
Area of Science:
- Critical Care Medicine
- Hematology
- Environmental Health
Background:
- Heat stroke (HS) is a severe heat-related illness with a high mortality rate.
- Disseminated intravascular coagulation (DIC) frequently complicates HS, worsening patient prognosis.
- Current DIC diagnostic scores often lack the sensitivity for early detection in HS patients.
Purpose of the Study:
- To identify early predictors of DIC in patients diagnosed with heat stroke.
- To develop and validate a predictive model for early DIC identification in HS.
Main Methods:
- Retrospective analysis of clinical data from 219 heat stroke patients (2008-2020).
- Logistic regression analysis to identify independent risk factors for DIC.
- Construction and external validation of a predictive model using receiver operating characteristic (ROC) curves.
Main Results:
- Nine independent risk factors for DIC in HS were identified, including lactate dehydrogenase (LDH) and neutrophil-lymphocyte ratio (NLR).
- A predictive model incorporating the logarithm of LDH (InLDH) and the logarithm of NLR (InNLR) demonstrated high predictive efficacy (AUC=0.928).
- A nomogram based on InLDH and InNLR was developed, showing excellent discrimination and calibration.
Conclusions:
- Neutrophil percentage, lymphocyte count/percentage, CKMB, LDH, AST, NLR, MLR, and rhabdomyolysis are significant risk factors for DIC in HS.
- The predictive model utilizing InLDH and InNLR effectively predicts DIC incidence in heat stroke patients.
- The developed nomogram facilitates early DIC identification and timely treatment initiation for HS patients.
Background:
Heat stroke (HS), a potentially fatal heat-related illness, is often accompanied by disseminated intravascular coagulation (DIC) early, resulting in a poorer prognosis. Unfortunately, diagnosis by current DIC scores is often too late to identify DIC. This study aims to investigate the predictors and predictive model of DIC in HS to identify DIC early.
Methods:
This retrospective study analyzed clinical data of patients with HS in a tertiary hospital from January 1, 2008 to December 31, 2020. Univariate and multivariate logistic regression analyses were employed to identify the risk factors for DIC in HS. The predictive models based on these risk factors were constructed and externally validated, and their predictive efficacy was evaluated using receiver operating characteristic curves.
Results:
A total of 219 HS patients, including 49 with DIC, were included. The independent risk factors for DIC were identified as follows: neutrophil percentage (Neu%), lymphocyte count, lymphocyte percentage (Lym%), creatine kinase-MB (CKMB), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and rhabdomyolysis (RM). After logarithmization, the final predictive model based on the logarithm of lactate dehydrogenase (InLDH; odds ratio (OR) = 9.266, 95% confidence interval (95%CI; 4.379-19.607), p < 0.0001) and the logarithm of neutrophil-lymphocyte ratio (InNLR; OR = 3.393, 95%CI (1.834-6.277), p < 0.0001) was constructed with the largest area under the curve (0.928). A nomogram incorporating InLDH and InNLR was developed and showed excellent discrimination and calibration capabilities.
Conclusion:
Nine independent risk factors were identified for the occurrence of DIC in HS patients. The predictive model based on InLDH and InNLR can effectively predict the incidence of DIC. A nomogram based on InLDH and InNLR was developed to facilitate early identification and timely treatment of DIC in HS patients.
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