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投稿时间:2022-10-26 网络发布日期:2023-07-19
投稿时间:2022-10-26 网络发布日期:2023-07-19
中文摘要: 目的 探索多重耐药肺炎克雷伯杆菌(MDR-KP)院内感染患者预后的影响因素,并构建预后预测的列线图模型。方法 收集北京市某三级医院2016年12月至2020年12月所有发生MDR-KP院内感染的病例168例,根据预后分为死亡组41例和生存组127例,使用Lasso回归分析得到关联强度较高的危险因素,将其纳入基于R语言的“rms”包进行分析并构建模型。结果 Lasso回归分析显示,年龄≥80岁、抢救史、感染前30d呼吸机使用史、感染前30d输血史、感染前3个月手术史、感染前30d胸腔穿刺史、感染部位位于肺部及下呼吸道为MDR-KP感染患者发生死亡的独立危险因素,分析得到相应的列线图预测模型。模型在训练集和测试集中ROC曲线下面积(AUC)分别为0.834(95%CI: 0.753~0.915)、0.744(95%CI: 0.590~0.897)。
结论 根据模型评估数据及图表,该MDR-KP院内感染预后预测的列线图预测模型具有较好的检验效能及拟合优度,有助于临床早期识别不良预后患者,尽早采取相关临床干预措施。
中文关键词: 多重耐药肺炎克雷伯杆菌 院内感染 列线图模型 预后预测
Abstract:Objective To explore the prognostic influencing factors of patients with multidrug-resistant Klebsiella pneumoniae (MDR-KP) nosocomial infection and to construct a nomogram model for prognosis prediction.
Methods A total of 168 cases of MDR-KP nosocomial infection in a tertiary hospital in Beijing from December 2016 to December 2020 were selected and divided into death group (n=41) and survival group (n=127) according prognosis. Lasso logistic regression was performed to obtain the risk factors of higher correlation with prognosis of the patients, which was incorporated into the “rms” package based on R language for analysis and model construction.
Results Lasso regression analysis showed that age ≥ 80 years, rescue history, ventilator use and blood transfusion 30 days before infection, surgical history 3 months before infection, chest puncture 30 days before infection and infection in the lungs and lower respiratory tract were the independent risk factors for death outcome in patients with MDR-KP. Based on the above risk factors, the corresponding nomogram model was constructed for prediction. The area under the ROC curve (AUC) in the training set and test set for modelling were 0.834(95%CI: 0.753-0.915) and 0.744(95%CI: 0.590-0.897), respectively.
Conclusion The nomogram model for prognosis prediction of MDR-KP nosocomial infection has good test efficiency and goodness of fit, which helps to identify patients with poor prognosis in early clinical stage and take relevant clinical intervention measures as soon as possible.
keywords: Multidrug-resistant Klebsiella pneumoniae Nosocomial infection Nomogram model Prognostic prediction
文章编号: 中图分类号:R563.1 文献标志码:B
基金项目:
Author Name | Affiliation |
FAN Shuaihua*, WU Sheng, LIN Jinlan, MU Xiangdong, GUO Jun | *School of Clinical Medicine, Tsinghua University, Beijing 100089, China |
引用文本:
范帅华,吴圣,林金兰,等.多重耐药肺炎克雷伯杆菌院内感染患者预后预测列线图模型的构建及验证[J].中国临床研究,2023,36(7):1033-1037.
范帅华,吴圣,林金兰,等.多重耐药肺炎克雷伯杆菌院内感染患者预后预测列线图模型的构建及验证[J].中国临床研究,2023,36(7):1033-1037.