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在全膝关节整形术后进行术后输血的临床预测模型:系统性审查和元分析

Jingwen Chen¹, Xiaoping Zhong¹, Yaojie Zhai¹

¹The Third Clinical College of Guangzhou Medical University, The Nursing College of Guangzhou Medical University, Guangzhou, China.

BMC musculoskeletal disorders

|October 2, 2025

概括

临床预测模型显示,在全膝关节整形术后识别需要输血的患者具有前途. 然而,所有审查的模型都有高偏差风险,限制了它们目前的临床使用.

科学领域:

整形外科手术整形外科手术
医疗信息学医疗信息学
基于证据的医学基于证据的医学.

背景情况:

手术后输血是全膝关节整形术 (TKA) 的一个重要问题.
临床预测模型旨在识别有风险的患者进行有针对性的血液管理.
关于现有的TKA输血预测模型的预测性能,方法质量和临床适用性存在不确定性.

研究的目的:

系统地审查和评估TKA术后输血现有的预测模型.
评估这些模型的预测性能和方法质量.

主要方法:

在2025年2月之前,对10个数据库 (英语和中文) 进行了系统审查.
数据提取遵循了预测建模研究 (CHARMS) 系统审查的批判性评估和数据提取清单.
偏差风险和适用性使用预测模型风险偏差评估工具 (PROBAST) 进行评估.
使用随机效应的元分析汇集了AUC值,并进行了灵敏度和子组分析.

主要成果:

包括12项研究与18个模型,利用后勤回归或机器学习.
常见的预测因素包括手术前的血红蛋白,年龄,BMI,手术持续时间,以及使用胺酸.
内部验证模型的聚合AUC为0.83,表明了良好的预测歧视.
所有模型都表现出高偏差风险,原因是研究设计和报告缺陷.

结论:

现有的TKA输血预测模型显示了中等到优秀的歧视.
然而,由于方法上的缺陷和外部验证不足,所有模型都有很高的偏差风险.
未来的研究必须优先提高方法严谨性,并进行多中心的临床实用性外部验证.

关键词:

输血输血输血输血输血输血输血输血临床预测模型的临床预测模型.进行元分析分析.系统审查是系统的审查.整体膝关节关节整形术膝关节整形术

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