Influencing factors analysis and risk prediction model construction of diabetic nephropathy with cardiovascular disease

Lu Man; Zhou Xiaochun; Liu Fangxiang; Wang Jianqin

doi:10.3760/j.issn.1673-4777.2023.12.012

Abstract：Objective To analyze the influencing factors of diabetic nephropathy(DN)with cardiovascular disease and to construct a risk prediction model.Methods The clinical data of 1 208 patients with DN hospitalized in Lanzhou University Second Hospital from January 2015 to June 2022 were retrospectively collected to clarify the distribution characteristics of cardiovascular disease in DN.Patients were divided into combined group(505 cases)and non-combined group(703 cases)according to whether they had cardiovascular disease.The influencing factors of combined cardiovascular diseases in DN were analyzed by multivariate Logistic regression analysis.A risk prediction model was constructed,receiver operating characteristic(ROC)curves were used to assess the predictive efficacy of the model,and Hosmer-Lemeshow goodness of fit test was used to assess the calibration ability.Results Among 1 208 patients with DN,505 patients(41.8％)had cardiovascular disease.The prevalence of central vascular disease in patients of chronic kidney disease 1-5 stages were 29.9％(141/472),42.3％(203/480),62.8％(118/188),64.7％(33/51),and 58.8％(10/17),respectively,and the differences were statistically significant comparing the prevalence of cardiovascular disease in each stage(P＜0.001).The results of multivariate Logistic regression analysis showed that advanced age,hypertension,carotid plaque,blood uric acid and parathyroid hormone were risk factors for the development of cardiovascular disease,and blood albumin was a protective factor for the development of cardiovascular disease(all P＜0.05).The risk prediction model for the development of cardiovascular disease in DN was constructed.The area under the ROC curve of the risk prediction model was 0.787(95％confidence interval:0.762-0.812,P＜0.001),and the optimal cut-off value of 44.3％was selected with the maximum value of the Youden index of 0.442,at which the sensitivity of the ROC curve was 74.3％and the specificity was 70.0％.The Hosmer-Lemeshow test showed a good fit between the predicted value of the model and the actual situation(x2=5.896,P=0.659).Conclusions Advanced age,hypertension,carotid plaque,blood albumin,blood uric acid and parathyroid hormone are the influencing factors of DN patients with cardiovascular disease.The risk prediction model of DN combined with cardiovascular disease constructed based on the above influencing factors has a good predictive value.