Full
Outline
To explore the influencing factors of adrenal crisis(AC) in children with nephrotic syndrome.To construct a risk prediction model,and validate its performance.
A total of 436 children with nephrotic syndrome admitted to the department of pediatric nephrology and rheumatology of a tertiary hospital in Guangdong province from May 2021 to May 2024 were selected as the study subjects.The children were divided into a training set(305 cases) and a validation set(131 cases) at a ratio of 7∶3.LASSO regression analysis and ten-fold cross-validation were used to screen significant variables influencing the occurrence of AC in children with nephrotic syndrome.Logistic regression analysis was employed to identify the influencing factors of AC in children with nephrotic syndrome.The performance of the model was evaluated using the area under the receiver operating characteristic curve(AUC),the Hosmer-Lemeshow goodness-of-fit test,calibration curves,and clinical decision curves.
Among the 436 children with nephrotic syndrome,60(13.76%) developed AC.Logistic regression analysis showed that the type of hormone effect,nephrotic syndrome recurrence>3 times,concurrent infection,previous history of AC,irregular use of traditional Chinese medicine,and excessively rapid hormone tapering or abrupt withdrawal were influencing factors for AC in children with nephrotic syndrome(all P<0.05).In the training set,the AUC was 0.831,the sensitivity was 0.767,the specificity was 0.756,the Kappa value was 0.343,and the Youden index was 0.523.In the validation set,the AUC was 0.855,the sensitivity was 1.000,the specificity was 0.561,the Kappa value was 0.249,and the Youden index was 0.561.The calibration curves of both the training set and the validation set were close to the ideal curves.The Hosmer-Lemeshow test yielded a χ2 of 1.131(P=0.769) for the training set and a χ2 of 7.271(P=0.064) for the validation set.The clinical decision curves indicated that the risk threshold probability ranged from 0.02 to 0.94 in the training set and from 0.02 to 0.60 in the validation set.
The risk prediction model for AC in children with nephrotic syndrome demonstrated good discrimination,accuracy,and clinical decision-making performance,which may assist healthcare providers in the early identification of children with nephrotic syndrome at risk of AC.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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