Construction and Verification of Predictive Model for Influencing Factors of Quality of Life in Patients with Type 2 Diabetic Nephropathy: A Hospital-Based Retrospective Study.

Abstract

The influencing factors of quality of life (QOL) in patients with type 2 diabetic nephropathy (T2DN) were explored, a practical risk prediction model was constructed and independent verification was conducted. The clinical data of 273 patients with T2DN in Tai'an Maternal and Child Health Care Center from February 2021 to February 2023 were used for retrospective analysis, and the patients were divided into modelling group (n = 173) and validation group (n = 100). According to 36-item short form health survey (SF-36) scores, the research subjects in the modelling group were divided further into poor group (n = 78) and good group (n = 95). Multivariate logistic regression was used in analysing the influencing factors of QOL and establishing a clinical prediction model based on the results. Then, a receiver operating characteristic (ROC) curve was used in evaluating the model's prediction efficiency. Remarkable differences in age, duration of diabetes, presence or absence of hypertension, education level, exercise frequency and family monthly income were found among the patients (p < 0.001). Multivariate logistic regression analysis suggested age ≥60 (odds ratio (OR) = 3.395, 95% CI = 1.269-9.083), duration of diabetes ≥3 years (OR = 4.574, 95% CI = 1.623-12.885), presence of hypertension (OR = 4.011, 95% CI = 1.490-10.796), education level of junior high school and below (OR = 7.318, 95% CI = 3.648-14.678), no or little exercise (OR = 3.948, 95% CI = 1.989-7.839) and family monthly income <3500 yuan (OR = 2.871, 95% CI = 1.089-7.573) are risk factors for poor QOL (p < 0.05). The regression model was logit (p) = -5.412 + 1.222X1 + 1.520X2 + 1.389X3 + 1.990X4 + 1.373X5 + 1.055X6 (X1 as age ≥60, X2 as duration of diabetes ≥3 years, X3 as presence of hypertension, X4 as education level of below junior high school, X5 as no or little exercise and X6 as family monthly income <3500 yuan). Based on this model, the ROC curve showed that the AUC value, standard error and 95% CI were 0.842, 0.043 and 0.758-0.926, respectively. An analysis was made on the re-included 100 patients, and the predictive sensitivity, specificity and Kappa coefficient of the constructed model were 82.10%, 86.90% and 0.703. Age ≥60, duration of diabetes ≥3 years, presence of hypertension, education level of junior high school and below, no or little exercise and family monthly income <3500 yuan were independent influencing factors for poor QOL in patients with T2DN. The use of this model has certain clinical application value.