| ObjectiveThis study is to investigate the related risk factors of Chemotherapy-induced myelosuppression of elderly lung cancer patients,and to establish and validate a risk prediction model for Chemotherapy-induced myelosuppression of elderly lung cancer patients.The aim is to provide reference for preventive and nursing measures of Chemotherapy-induced myelosuppression.Methods1.Analysis of risk factors of Chemotherapy-induced myelosuppression of elderly lung cancer patients.228 Elderly patients receiving chemotherapy for lung cancer in the Department of Respiratory Medicine of a Grade A hospital in Zhenjiang City from May 1,2018 to May 1,2019 were selected by convenience sampling method.General clinical history data,data related to lung cancer chemotherapy and laboratory examination data were collected by referring to the patient’s medical record system and nursing document writing system.Patients with myelosuppression were screened according to the World Heal Organization（WHO）acute and subacute toxicity response grading standards of antitumor drugs.According to the occurrence of myelosuppression,elderly patients with lung cancer chemotherapy were divided into myelosuppression group and nonmyelosuppression group.Univariate analysis was used to preliminarily screen the risk factors of chemotherapy-induced myelosuppression of elderly lung cancer patients.Significant risk factors from univariate analysis were then analyzed by binary Logistic regression.It is to investigate the independent risk factors of Chemotherapy-induced myelosuppression of elderly lung cancer patients.2.Construction and validation of risk prediction model for chemotherapy-induced myelosuppression of elderly lung cancer patients.The partial regression coefficient,odds ratio and 95% confidence interval of independent risk factors were determined by binary Logistic regression analysis.The calculation formula of risk prediction model was obtained.A Logistic regression model for chemotherapy-induced myelosuppression of elderly lung cancer patients was constructed.The risk prediction model was put into the regression equation and the area under receiver operating characteristic curve（AUC）was plotted to obtain the sensitivity and specificity of the prediction model under different score values,and the Youden index（sensitivity+specificity-1）was calculated to determine the critical point by maximizing the Youden index.The risk prediction model was evaluated by internal validation and external validation.The internal validation of the model was evaluated by AUC and HosmerLemeshow test on 228 patients who constructed the model.The external validation of the model was evaluated by 108 Elderly patients who receiving chemotherapy for lung cancer in the Department of Respiratory Medicine of a Grade A hospital in Zhenjiang City from January 1,2020 to October 1,2020 were selected by convenience sampling method as independent validation model data set to verify the fitting effect of the model.ResultsGeneral backgrounds 336 elderly lung cancer patients who met the criteria for chemotherapy were collected.Among them,228 cases were in the model group,75 patients developed myelosuppression,and the incidence of chemotherapy-induced myelosuppression of elderly lung cancer patients was 32.8%.Among 108 patients in the validation group,36 patients developed myelosuppression,and the incidence of chemotherapy-induced myelosuppression of elderly lung cancer patients was 33.3%.Univariate analysis showed that hypertension disease,coronary atherosclerotic heart disease,diabetes,smoking history,combined with other adverse reactions,Morse Fall Scale,the types of lung cancer,lung cancer staging,platinum-based chemotherapy regimen,number of chemotherapy,reduced white blood cell count before chemotherapy,reduced hemoglobin before chemotherapy,reduced platelet count before chemotherapy,reduced albumin before chemotherapy are the potential risk factors of chemotherapy-induced myelosuppression of elderly lung cancer patients（P<0.05）.By logistic regression analysis,4 significant risk factors were identified for chemotherapyinduced myelosuppression of elderly lung cancer patients.There are combined with other adverse reactions（OR=5.006,95%CI:1.658-15.485）,that platinum-based chemotherapy regimen（OR=7.052,95%CI:2.510-19.811）,reduced hemoglobin before chemotherapy（OR=6.585,95%CI:2.656-16.329）,reduced albumin before chemotherapy（OR=2.184,95%CI:1.106-4.312）.The formula of the risk prediction model in this study is P=1/1+exp（3.247-1.623× combined with other adverse reactions（0,1）-1.953× platinum-based chemotherapy regimen（0,1）-1.885× reduced hemoglobin before chemotherapy（0,1）-0.781× reduced albumin before chemotherapy（0,1））.In this study,by plotting AUC,the maximum value of Youden index was 0.5,and the corresponding cut off value was 0.287.In the internal validation of the model,the P value of Hosmer-Lemeshow test was 0.449,AUC was 0.823,the specificity was70.5%,the sensitivity was 81.3%,and the overall prediction accuracy was 74.1%.In the external validation of the model,AUC was 0.882,the specificity was71.7%,the sensitivity was 88.9%,and the overall prediction accuracy was 76.8%.These outcomes display that the model can precisely forecast the incidence of chemotherapy-induced myelosuppression of elderly lung cancer patients.ConclusionsThe incidence of chemotherapy-induced myelosuppression of elderly lung cancer patients is higher.The combined with other adverse reactions,platinum-based chemotherapy regimens,reduced hemoglobin before chemotherapy and reduced albumin before chemotherapy are independent risk factors for chemotherapy-induced myelosuppression of elderly lung cancer patients.In this study,the corresponding cut off value of the model was 0.287.It has been proved that the model is accurate in predicting chemotherapy-induced myelosuppression of elderly lung cancer patients.Therefore,it indicates that patient may have chemotherapy-induced myelosuppression when the corresponding cut off value of the model is greater than 0.287.Clinical nurse should be vigilant and carry out nursing intervention as soon as possible,and medical intervention should be carried out under the guidance of doctors when necessary.When the corresponding cut off value is in the critical state,attention should also be paid. |
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