mPCNL术后尿源性脓毒血症风险因素分析及基于诺模图的预测模型建立

Analysis of risk factors for urogenic sepsis after mPCNL and development of a predictive model based on Nomogram

目的探讨微通道经皮肾镜碎石术(mPCNL)后发生尿源性脓毒血症的相关独立风险因素,并建立其风险预测模型。方法选取我院泌尿外科2020年1月至2021年12月期间,因上尿路结石行mPCNL治疗的122例患者的临床资料,进行回顾性分析。通过采用单因素及多因素Logistic回归分析围手术期指标与mPCNL术后尿源性脓毒血症的关系,筛选出独立危险因素,并由此建立尿源性脓毒血症的Logistic回归预测模型,计算OR值并构建诺模图。进行数据可视化处理,并采用Hosmer-Lemeshow检验和校准曲线来测验该预测模型的拟合优度,评估其预测能力和准确性,并通过ROC曲线下面积来对预测模型的效能进行评定。结果在本研究共计122例行mPCNL术的患者中,术后发生尿源性脓毒血症的例数为10例,发生率为8.2%。通过单因素Logistic回归分析显示结石最大直径、手术时间和mPCNL术后发生尿源性脓毒血症有一定的关系(P<0.05)。多因素Logistic逐步回归分析显示结石最大直径、手术时间是mPCNL术后发生尿源性脓毒血症的独立危险因素。逐步回归预测模型:Logit(P)=-7.556+1.097×结石最大直径(cm)+1.029×手术时间(min)。ROC曲线下面积为0.832(95%CI为0.6650.999,P<0.001)。Hosmer-Lemeshow检验该模型成立,且预测效能较好(P>0.05)。结论本研究结果显示结石最大直径、手术时间是mPCNL后患者发生尿源性脓毒血症的独立危险因素,基于上述危险因素建立的诺模图模型可准确评估和量化mPCNL后发生尿源性脓毒血症的风险。

Objective To explore the relevant independent risk factors of urogenic sepsis after minimally percutaneous nephrolithotomy(mPCNL),and to establish a risk prediction model.Methods The clinical data of 122 patients with upper urinary tract calculi who underwent mPCNL from January 2020 to December 2021 in our department of urology were retrospectively analyzed.The relationship between perioperative indicators and urogenic sepsis after mPCNL was analyzed by single factor and multivariate Logistic regression,and independent risk factors were screened out,and a logistic regression predictive model of urogenic sepsis was established based on this.The OR value was calculated and the data was simultaneously visualized.Hosmer-Lemeshow test and calibration curve are used to test the goodness of fit of the prediction model,evaluate its prediction ability and accuracy,and evaluate the effectiveness of the prediction model through the area under the ROC curve.Results Among the 122 patients who underwent mPCNL surgery in this study,10 cases of urogenic sepsis occurred after surgery,with an incidence rate of 8.2%.Single factor Logistic regression analysis showed that the maximum diameter of stones and operation time had a certain relationship with urogenic sepsis after mPCNL(P<0.05).Multivariate logistic regression analysis showed that the maximum diameter of stones and operation time were independent risk factors for urogenic sepsis after mPCNL.Stepwise regression prediction model:Logit(P)=-7.556+1.097×maximum diameter of stone+1.029×operation time.The ROC curve is 0.832(95%CI is 0.6650.999,P<0.001).Hosmer-lemeshow Tests showed that the model was established,and predictive efficiency was better(P>0.05).Conclusion The results of this study showed that the operation time and maximum diameter of stones are independent risk factors for urogenic sepsis in patients after mPCNL.The nomogram established based on the above risk factors can accurately assess and quantify the risks of urogenic sepsis after mPCNL.