Ⅲ—Ⅳ期肺癌免疫检查点抑制剂治疗30天内非计划再入院风险预测模型

doi:10.3969/j.issn.1006-5725.2026.01.001

Abstract

Abstract:

Objective To identify risk factors for unplanned 30-day readmission （UPR） following immune checkpoint inhibitors （ICIs） treatment in stage Ⅲ—Ⅳ lung cancer patients and to develop/validate a predictive model. Methods We retrospectively analyzed clinical data from stage Ⅲ—Ⅳ lung cancer patients treated with ICIs at our institution （January 2023-May 2024）. Risk factors were preliminarily screened using the Boruta algorithm； independent predictors were identified via logistic regression. A nomogram prediction model was subsequently developed. Model performance was evaluated by： discrimination （receiver operating characteristic curves， ROC）， calibration （calibration plots）， and clinical utility （decision curve analysis， DCA）. Restricted cubic spline （RCS） regression combined with SHapley Additive exPlanations （SHAP） analysis further explored dose-response relationships and threshold effects of key risk factors on UPR. Results Among 284 included patients， the UPR incidence was 30.63%. Independent risk factors identified by logistic regression were： hospital length of stay， Nutritional Risk Screening 2002 （NRS 2002） score， invasive procedures， and Karnofsky Performance Status （KPS） score （all P < 0.05）. The model showed strong discrimination： training set AUC = 0.88 （95% CI： 0.84 ~ 0.93）， sensitivity 84%， specificity 80%； validation set AUC = 0.87 （95% CI： 0.79 ~ 0.95）， sensitivity 82%， specificity 70%. Calibration curves indicated good model fit. Decision curve analysis demonstrated positive net benefit at threshold probabilities of 10%~90%. SHAP analysis prioritized length of stay as the most influential predictor； SHAP-RCS analysis revealed increased UPR risk when： hospital stay > 6.43 days， NRS 2002 > 2.05， KPS < 79.01， or prior invasive procedures. Conclusion The nomogram model incorporating four key risk factors effectively predicts 30-day unplanned readmission risk in stage Ⅲ—Ⅳ lung cancer patients receiving ICI therapy. With robust performance and clinical utility， it may facilitate early identification and intervention for high-risk individuals.

Key words: lung neoplasms, immune checkpoint inhibitors, unplanned readmission, boruta algorithm, predictive model

CLC Number:

R473

Bo DENG,Caoxia PENG,Qilian XIONG,Weiqi NIAN,Ying LIU. Predictive model for unplanned 30-day readmission in stage Ⅲ—Ⅳ lung cancer patients receiving immune checkpoint inhibitors[J]. The Journal of Practical Medicine, 2026, 42(1): 1-11.

Figures/Tables 7

Tab.1

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Tab.2

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References 48

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变量	验证集（n = 84）	训练集（n = 200）	t/Z/χ²值	P值
年龄（x ± s）/岁	65.39 ± 9.78	64.75 ± 10.41	0.47	0.63
住院天数［M（P₂₅，P₇₅）］/d	5.00（3.00， 9.00）	5.00（3.00， 10.00）	0.03	0.98
性别			0.37	0.54
女	27（32.1）	57（28.5）
男	57（67.9）	143（71.5）
吸烟			0.14	0.71
无	32（38.1）	81（40.5）
有	52（61.9）	119（59.5）
饮酒			3.21	0.07
无	42（50.0）	123（61.5）
有	42（50.0）	77（38.5）
介入治疗			0.005	0.95
无	70（83.3）	166（83.0）
有	14（16.7）	34（17.0）
远端转移			0.30	0.58
无	21（25.0）	44（22.0）
有	63（75.0）	156（78.0）
TNM			0.05	0.82
Ⅲ期	22（26.2)	55（27.5)
Ⅳ期	62（73.8)	145（72.5)
KPS			0.09	0.76
< 70分	20（23.8)	51（25.5)
≥ 70分	64（76.2)	149（74.5)
NRS 2002			0.80	0.37
< 3分	65（77.4)	164（82.0)
≥ 3分	19（22.6)	36（18.0)
TCMD			1.79	0.18
虚证	71（84.5)	155（77.5)
实证	13（15.5)	45（22.5)
RBC			0.04	0.83
低	28（33.3)	64（32.0)
正常	56（66.7)	136（68.0)
Hb			0.09	0.76
低	28（33.3)	63（31.5)
正常	56（66.7)	137（68.5)
WBC			0.37	0.83
< 3.5 × 10⁹/L	65（77.4)	148（74.0)
3.5 ~ 9.5 × 10⁹/L	12（14.3)	32（16.0)
≥ 9.5 × 10⁹/L	7（8.3)	20（10.0)
NEUT			2.88	0.24
< 1.8 × 10⁹/L	60（71.4)	149（74.5)
1.8 ~ 6.3 × 10⁹/L	11（13.1)	14（7.0)
≥ 6.3 × 10⁹/L	13（15.5)	37（18.5)
PLT			0.48	0.79
< 125 × 10⁹/L	54（64.3)	136（68.0)
125 ~ 350 × 10⁹/L	24（28.6)	53（26.5)
≥ 350 × 10⁹/L	6（7.1)	11（5.5)
CRP			2.57	0.11
≤ 10 mg/L	44（52.4)	84（42.0)
> 10 mg/L	40（47.6)	116（58.0)
ALB			0.40	0.53
< 40 g/L	31（36.9)	66（33.0)
40 ~ 55 g/L	53（63.1)	134（67.0)
AFP			2.11	0.15
0 ~ 7 mg/L	71（84.5)	181（90.5)
> 7 mg/L	13（15.5)	19（9.5)
CEA			0.58	0.44
0 ~ 5 mg/L	51（60.7)	131（65.5)
> 5 mg/L	33（39.3)	69（34.5)
CA19-9			0.03	0.86
0 ~ 37 U/mL	63（75.0)	148（74.0)
> 37 U/mL	21（25.0)	52（26.0)
CA50			0.26	0.61
0 ~ 25 U/mL	65（77.4)	149（74.5)
> 25 U/mL	19（22.6)	51（25.5)

变量	单因素分析		多因素分析
变量	OR（95%CI）	P值	OR（95%CI）	P值
住院天数	1.115（1.06 ~ 1.169）	< 0.01	1.11（1.03 ~ 1.19）	< 0.01
介入治疗
否	Ref		Ref
是	5.26（2.41 ~ 11.47）	< 0.01	11.34（3.51 ~ 36.63）	< 0.01
CRP
≤ 10 mg/L	Ref		Ref
> 10 mg/L	2.91（1.48 ~ 5.71）	< 0.01	1.46（0.60 ~ 3.56）	0.4
CA19-9
0 ~ 37 U/mL	Ref		Ref
> 37 U/mL	2.379（1.23 ~ 4.61）	0.01	0.65（0.17 ~ 2.49）	0.53
CA50
0 ~ 25 U/mL	Ref		Ref
> 25 U/mL	2.79（1.43 ~ 5.43）	0.003	1.61（0.43 ~ 5.96）	0.47
KPS
< 70分	Ref		Ref
≥ 70分	0.18（0.089 ~ 0.35）	< 0.01	0.22（0.08 ~ 0.58）	< 0.01
NRS 2002
< 3分	Ref		Ref
≥ 3分	11.90（5.11 ~ 27.74）	< 0.01	8.86（3.06 ~ 25.62）	< 0.01
TCMD
虚证	Ref		Ref
实证	0.81（0.39 ~ 1.71）	0.58	0.92（0.43 ~ 1.81）	0.62

Predictive model for unplanned 30-day readmission in stage Ⅲ—Ⅳ lung cancer patients receiving immune checkpoint inhibitors

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