Abstract
OBJECTIVES: The annual growth in the population of maintenance hemodialysis (MHD) patients is accompanied by a trend towards younger age groups among new cases. Despite the escalating mortality risk observed in MHD patients, there remains a dearth of research focused on young and middle-aged individuals in this cohort, leading to a deficiency in specialized predictive instruments for this demographic. This research seeks to explore the critical determinants impacting mortality risk in young and middle-aged MHD patients and to construct a prediction model accordingly. METHODS: This study involved 127 young and middle-aged patients undergoing MHD in the Blood Purification Center of Chaohu Hospital of Anhui Medical University from January 2019 to January 2022. The follow-up period for each patient ended either at the time of death or on January 31, 2024. Participants were monitored to determine their survival status and categorized into two groups: those who survived (98 patients) and those who deceased (29 patients). Clinical data were gathered for analysis. Logistic regression was utilized to pinpoint independent risk factors for mortality among these patients. Subsequently, a nomogram was established to predict mortality risk. The efficacy of this model was assessed through the area under the receiver operating characteristic curve (AUC-ROC), alongside a calibration curve and the Hosmer-Lemeshow test to examine its fit. Additionally, decision curve analysis (DCA) was conducted to ascertain the clinical relevance of the predictive model. RESULTS: The study incorporated 127 young and middle-aged patients undergoing MHD, with a mortality rate recorded at 22.83% (29 cases). A logistic regression analysis revealed that age, hemoglobin (HB), serum magnesium (Mg), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-albumin ratio (PAR) were significant independent predictors of mortality among these patients. Utilizing these variables, a nomogram was developed to predict mortality risk, achieving an AUC of 0.899 (95% CI: 0.833-0.966). The model exhibited a specificity of 83.67% and a sensitivity of 82.76%, demonstrating substantial discriminative ability. The model's robustness was confirmed through internal validation with 1,000 bootstrap samples, yielding an AUC of 0.894 (95% CI: 0.806-0.949). The calibration curve closely aligned with the ideal curve, and the Hosmer-Lemeshow goodness-of-fit test yielded a χ (2) value of 6.312 with a p-value of 0.612, verifying the model's high calibration accuracy. Additionally, the DCA indicated that the model provides a net benefit across a wide range of decision thresholds from 0 to 0.99, underscoring its clinical utility. CONCLUSION: The nomogram developed from variables including age, HB levels, serum Mg, NLR, and PAR exhibits high levels of discrimination and calibration. This model effectively predicts mortality risk among young and middle-aged patients undergoing MHD, proving its clinical relevance.