Construction of a nomogram prediction model for the prognosis of patients with depressive disorder based on the characteristics of peripheral blood lymphocyte subsets

doi:10.3969/j.issn.1673-8640.2025.12.002

Abstract

Abstract:

Objective To construct a nomogram prediction model for the prognosis of patients with depressive disorder based on peripheral blood lymphocyte subsets，and to evaluate its clinical applicability. Methods A total of 166 patients with depressive disorder from Shaoxing Seventh People's Hospital from May 2021 to June 2022 were enrolled as modeling set. All the patients received conventional antidepressant treatment，and they were followed up for 1 year after discharge. The prognosis of patients with depressive disorder was evaluated using the Global Assessment Scale（GAS） at the last follow-up. Totally，77 patients with a GAS score ≤60 were classified in poor prognosis group，and 89 patients with a GAS score >60 were classified in good prognosis group. Another 72 patients with depressive disorder from Shaoxing Seventh People's Hospital from October 2022 to June 2023 were enrolled as validation set for external validation of the nomogram prediction model. The clinical data were collected，and the percentages of peripheral blood T lymphocyte subset percentages（CD3⁺%，CD4⁺%，CD8⁺%） and dehydroepiandrosterone sulfate（DHEAS） levels were determined. The CD4/CD8 ratio was calculated. Receiver operating characteristic（ROC） curve was used to evaluate the efficacy of each index in predicting poor prognosis in patients with depressive disorder. Binary Logistic regression analysis was used to evaluate the influencing factors of prognosis in patients with depressive disorder. Calibration curves and decision curves were used to internally validate and evaluate the performance of the nomogram prediction model. Results There was statistical significance in gender，CD3⁺%，CD4⁺%，CD8⁺%，CD4/CD8 ratio and DHEAS level between poor prognosis group and good prognosis group in the modeling set（P<0.001），while there was no statistical significance in the other clinical data between the 2 groups（P>0.05）. Gender，CD3⁺%，CD4⁺%，CD8⁺%，CD4/CD8 ratio and DHEAS were all risk factors for poor prognosis in patients with depressive disorder（P<0.05）. A nomogram prediction model for predicting the prognosis of patients with depressive disorder was constructed based on the regression equation. The area under curve（AUC） of the nomogram prediction model for predicting poor prognosis in patients with depressive disorder was 0.964，and the C-index was 0.963. The model had a good fit（Hosmer-Lemeshow χ²=11.507，P=0.175）. When the threshold probability was >0.14，clinical net benefit could be obtained，and the maximum net benefit was 0.30. In the validation set，the AUC of the nomogram prediction model for predicting poor prognosis in patients with depressive disorder was 0.920，and the model had a good fit（Hosmer-Lemeshow χ²=6.782，P=0.553）. Conclusions The nomogram prediction model constructed based on gender，CD3⁺%，CD4⁺%，CD8⁺%，CD4/CD8 ratio and DHEAS can effectively evaluate the prognosis of patients with depressive disorder，and has good clinical applicability.

Key words: Lymphocyte subset, Depressive disorder, Prognosis, Nomogram model

CLC Number:

R446.1

GAO Zikang, CHEN Jing. Construction of a nomogram prediction model for the prognosis of patients with depressive disorder based on the characteristics of peripheral blood lymphocyte subsets[J]. Laboratory Medicine, 2025, 40(12): 1146-1152.

Figures/Tables 10

References 27

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组别	例数	性别				年龄/岁		BMI/ （kg·m^-2）		受教育程度
组别	例数	男/ [例（%）]		女/ [例（%）]		年龄/岁		BMI/ （kg·m^-2）		小学/ [例（%）]			初中/ [例（%）]	高中/ [例（%）]		大学及以上/[例（%）]
预后不良组	77	24（31.2）		53（68.8）		35.47±5.07		22.16±0.78		3（3.9）			13（16.9）	25（32.5）		36（46.8）
预后良好组	89	55（61.8）		34（38.2）		36.46±5.09		22.31±0.82		5（5.6）			15（16.9）	30（33.7）		39（43.8）
统计值		15.528				1.257		1.205		0.352
P值		<0.001				0.211		0.230		0.950
组别	独生子女/ [例（%）]		婚姻状况												抑郁障碍家族史/[例（%）]
组别	独生子女/ [例（%）]		已婚/[例（%）]		未婚/[例（%）]				离异/[例（%）]			丧偶/[例（%）]			抑郁障碍家族史/[例（%）]
预后不良组	27（35.1）		28（36.4）		31（40.3）				10（13.0）			8（10.4）			19（24.7）
预后良好组	36（40.4）		30（33.7）		35（39.3）				14（15.7）			10（11.3）			20（22.5）
统计值	0.508		0.335												0.112
P值	0.476		0.953												0.738
组别	CD3⁺%/%		CD4⁺%/%		CD8⁺%/%		CD4/CD8比值				DHEAS/（ng·mL^-1）
预后不良组	54.15±4.92		26.13±3.33		33.55±3.32		0.87±0.16				288.52±40.12
预后良好组	60.62±5.02		30.52±3.39		26.79±3.02		1.15±0.19				350.25±46.72
统计值	8.367		8.398		7.650		10.454				9.058
P值	<0.001		<0.001		<0.001		<0.001				<0.001

组别	例数	性别				年龄/岁		BMI/ （kg·m^-2）		受教育程度
组别	例数	男/ [例（%）]		女/ [例（%）]		年龄/岁		BMI/ （kg·m^-2）		小学/ [例（%）]			初中/ [例（%）]	高中/ [例（%）]		大学及以上/[例（%）]
预后不良组	77	24（31.2）		53（68.8）		35.47±5.07		22.16±0.78		3（3.9）			13（16.9）	25（32.5）		36（46.8）
预后良好组	89	55（61.8）		34（38.2）		36.46±5.09		22.31±0.82		5（5.6）			15（16.9）	30（33.7）		39（43.8）
统计值		15.528				1.257		1.205		0.352
P值		<0.001				0.211		0.230		0.950
组别	独生子女/ [例（%）]		婚姻状况												抑郁障碍家族史/[例（%）]
组别	独生子女/ [例（%）]		已婚/[例（%）]		未婚/[例（%）]				离异/[例（%）]			丧偶/[例（%）]			抑郁障碍家族史/[例（%）]
预后不良组	27（35.1）		28（36.4）		31（40.3）				10（13.0）			8（10.4）			19（24.7）
预后良好组	36（40.4）		30（33.7）		35（39.3）				14（15.7）			10（11.3）			20（22.5）
统计值	0.508		0.335												0.112
P值	0.476		0.953												0.738
组别	CD3⁺%/%		CD4⁺%/%		CD8⁺%/%		CD4/CD8比值				DHEAS/（ng·mL^-1）
预后不良组	54.15±4.92		26.13±3.33		33.55±3.32		0.87±0.16				288.52±40.12
预后良好组	60.62±5.02		30.52±3.39		26.79±3.02		1.15±0.19				350.25±46.72
统计值	8.367		8.398		7.650		10.454				9.058
P值	<0.001		<0.001		<0.001		<0.001				<0.001

项目	AUC（95%CI^①）	最佳临界值	敏感性/%	特异性/%	Youden指数
CD3⁺%	0.824（0.757~0.878）	55.4%	63.64	86.52	0.502
CD4⁺%	0.822（0.755~0.877）	29.0%	83.12	65.17	0.483
CD8⁺%	0.798（0.728~0.856）	27.7%	79.22	68.54	0.478
CD4/CD8比值	0.880（0.821~0.925）	0.95	75.32	91.01	0.663
DHEAS	0.848（0.784~0.899）	316.2 ng·mL^-1	75.32	80.90	0.562

项目	AUC（95%CI^①）	最佳临界值	敏感性/%	特异性/%	Youden指数
CD3⁺%	0.824（0.757~0.878）	55.4%	63.64	86.52	0.502
CD4⁺%	0.822（0.755~0.877）	29.0%	83.12	65.17	0.483
CD8⁺%	0.798（0.728~0.856）	27.7%	79.22	68.54	0.478
CD4/CD8比值	0.880（0.821~0.925）	0.95	75.32	91.01	0.663
DHEAS	0.848（0.784~0.899）	316.2 ng·mL^-1	75.32	80.90	0.562

项目	β值	标准误	Wald值	P值	OR^①值（95%CI）
性别	1.689	0.646	6.841	0.009	5.414（1.527~19.193）
CD3⁺%	0.557	0.196	8.076	0.003	1.746（1.246~2.861）
CD4⁺%	0.688	0.238	8.356	0.002	1.989（1.116~2.736）
CD8⁺%	0.731	0.244	8.975	<0.001	2.078（1.526~8.217）
CD4/CD8比值	1.107	0.388	8.140	0.003	3.025（2.369~4.028）
DHEAS	1.050	0.359	8.554	<0.001	2.857（2.589~3.121）