Abstract:

Objective To analyze the risk factors of ketoacidosis in children with type 1 diabetes mellitus （T1DM），and establish a risk prediction model of ketoacidosis in children with T1DM by using decision tree algorithm. Methods The clinical data of 218 children with T1DM treated from February 2021 to September 2024 were retrospectively analyzed. The children were divided into ketoacidosis group and non-ketoacidosis group according to whether they had ketoacidosis. The risk factors of ketoacidosis in children with T1DM were screened by Logistic regression analysis. A random forest model for predicting ketoacidosis in children with T1DM was constructed using R language，and the model was internally verified by using 5-fold cross-validation method，and the prediction efficiency of the model was compared. Results Among 218 children with T1DM，66 cases had ketoacidosis，and the incidence of ketoacidosis was 30.28%. Univariate factor results showed that age，blood glucose at admission，glycated hemoglobin，preinfection，thyroid function had statistically differences（P<0.05）. The Logistic regression results indicated that increased age was a protective factor for ketoacidosis in children with T1DM，while random elevation of blood glucose at admission，elevated glycated hemoglobin，presence of propositional infection，and thyroid dysfunction were risk factors for ketoacidosis in children with T1DM（P<0.05）. The overall accuracy of the model prediction was 84.2%. Internal verification showed that the prediction accuracy of the model was 77.6%. The AUC value of random forest model in predicting the occurrence of ketoacidosis in children with T1DM was similar to that of Logistic regression model，and both models had better predictive efficacy. Conclusion The random forest model constructed in this study can predict the risk of developing ketoacidosis in children with T1DM，which is helpful for nursing staff to formulate corresponding nursing intervention strategies according to the importance of different factors.

Key words: Type 1 Diabetes Mellitus, Children, Ketoacidosis, Influencing Factors, Random Forest Model