摘要
目的 分析行心脏外科手术治疗的患者术后发生导管相关性血流感染(CRBSI)的影响因素,并构建Nomogram预测模型。方法 选取2021年1—12月于天津市胸科医院行心脏外科手术的2 682例患者,按1:1比例将患者随机分为训练人群(1 341例)、验证人群(1 341例)。统计训练人群、验证人群CRBSI发生情况,比较发生与未发生CRBSI患者临床资料,在训练人群中通过logistic回归模型分析心脏外科术后CRBSI发生的影响因素,根据影响因素构建Nomogram预测模型,在验证人群采用受试者工作特征(ROC)曲线、决策曲线(DCA)对Nomogram预测模型进行验证。结果 训练人群与验证人群CRBSI发生率比较(2.46%vs. 2.39%),差异无统计学意义(P>0.05);在训练人群、验证人群中,发生与未发生CRBSI患者年龄、术前APACHEⅡ评分、预防性应用抗菌药、白细胞数目、置管时间、血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)水平比较差异明显,且上述因素均为心脏外科术后CRBSI发生的影响因素(P<0.05);年龄、术前APACHEⅡ评分、置管时间、血清PCT、hs-CRP水平与心脏外科术后CRBSI的发生呈正相关,预防性应用抗菌药、白细胞数目与心脏外科术后CRBSI的发生呈负相关(P<0.05);根据Nomogram预测模型获得患者发生CRBSI的概率,验证人群中Nomogram预测模型ROC曲线的AUC为0.961,从DCA观察到该模型预测具有明显的正向净收益。结论 心脏外科术后CRBSI受年龄、术前APACHEⅡ评分、预防性应用抗菌药、白细胞数目、置管时间、血清PCT、hs-CRP等影响,联合构建Nomogram预测模型具有较高预测价值,对预防术后CRBSI有指导意义。
Objective To analyze the influencing factors of catheter related blood stream infection(CRBSI)in patients undergoing cardiac surgery,and construct a Nomogram prediction model.Methods A total of 2682 patients who underwent cardiac surgery in our hospital from January 2021 to December 2021 were selected and randomly divided into a training population(1341 cases)and a validation population(1341 cases)at a ratio of 1:1.The incidence of CRBSI in the training population and the validation population was statistically analyzed,and the clinical data of patients with and without CRBSI were compared.The logistic regression model was used to analyze the influencing factors of CRBSI occurrence after cardiac surgery in the training population.The Nomogram prediction model was constructed based on the influencing factors,and the Nomogram prediction model was validated using the receiver operating characteristic(ROC)curve and decision curve analysis(DCA)in the validation population.Results There was no significant difference in the incidence of CRBSI between the trained group and the verified group(2.46%vs.2.39%)(P>0.05).There were significant differences in the age,preoperative APACHE II score,preventive use of antibiotics,white blood cell count,catheterization time,serum procalcitonin(PCT),and high-sensitivity C-reactive protein(hs-CRP)levels between patients with and without CRBSI in the training and validation populations,and all of these factors were risk factors for the occurrence of CRBSI after cardiac surgery(P<0.05).Age,preoperative APACHE II score,catheterization time,serum PCT,and hs-CRP levels were all positively associated risk factors for the occurrence of CRBSI after cardiac surgery,while preventive use of antibiotics and white blood cell count were both negatively associated risk factors(P<0.05).Based on the Nomogram prediction model,the probability of CRBSI occurrence in patients was obtained,and the ROC curve AUC of the Nomogram prediction model was 0.961 in the verified population.The positive net benefit was observed from DCA.Conclusion After cardiac surgery,CRBSI is affected by age,APACHE II score,prophylactic application of antibiotics,number of white blood cells,catheterization time,serum PCT,hs-CRP,and TGF-β1/Smads signaling pathway.This Nomogram model has high predictive value.It has guiding significance to prevent postoperative CRBSI.
作者
史媛
李会英
SHI Yuan;LI Huiying(Department of ICU,Tianjin Chest Hospital,Jinnan 300000,China)
出处
《中国煤炭工业医学杂志》
2024年第6期643-650,共8页
Chinese Journal of Coal Industry Medicine
基金
河北省医学科研课题计划(编号:20200761)
