慢性肾衰竭维持性血液透析患者医院感染风险的早期预测价值

Early predictive value of nosocomial infection risk in maintenance hemodialysis patients with chronic renal failure

目的探讨慢性肾衰竭维持性血液透析患者医院感染风险的早期预测价值。方法选择2020年6月-2022年12月平顶山市第二人民医院166例诊断为慢性肾衰竭维持性血液透析患者作为研究对象,根据是否并发院内感染分为感染组48例、非感染组118例。详细记录患者信息,多因素logistic回归分析影响患者感染发生因素,并用受试者工作特征(ROC)曲线分析危险因素的预测价值。结果感染组年龄≥60岁、透析时间≥1年、住院时间>30 d比例高于非感染组,差异均有统计学意义(χ^(2)=5.852、6.153、-3.194,P均<0.05)。感染组入院时白细胞(WBC)、血红蛋白(Hb)、白蛋白(ALB)低于非感染组,差异均有统计学意义(t=2.712、3.451、3.975,P均<0.05),入院时中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)高于非感染组,差异均有统计学意义(t=2.908、3.567,P均<0.05)。多因素logistic回归分析显示:高龄,WBC、ALB、Hb水平降低,NLR、PLR高是慢性肾衰竭维持性血液透析患者发生医院感染的危险因素(P<0.05)。预测分析显示:危险因素联合的曲线下面积(AUC)为0.910,灵敏度为93.8%,特异度为88.0%。结论慢性肾衰竭维持性血液透析患者,高龄、营养状况差、WBC降低等可增加医院感染的风险,上述危险因素联合对医院感染发生有较高的预测价值。

Objective To explore the early predictive value of nosocomial infection risk in maintenance hemodialysis patients with chronic renal failure.Methods From June 2020 to December 2022,166 maintenance hemodialysis patients diagnosed as chronic renal failure in the Pingdingshan Second People's Hospital were selected as the research object,and were divided into infection group(48 cases)and non-infection group(118 cases)according to whether they were complicated with nosocomial infection.The patient information was recorded in detail,and the factors influencing the occurrence of infection were analyzed by multivariate logistic regression,and its predictive value was analyzed by receiver operating characteristic(ROC)curve.Results The proportion of infection group's age≥60 years,dialysis time≥1 year and hospitalization time>30 days were higher than those of non-infection group(χ^(2)=5.852,6.153,-3.194;all P<0.05).The white blood cell(WBC),hemoglobin(Hb)and albumin(ALB)in the infection group were lower than those in the non-infection group(t=2.712,3.451,3.975;all P<0.05),and the neutrophil/lymphocyte ratio(NLR)and platelet/lymphocyte ratio(PLR)were higher than those in the non-infection group(t=2.908,3.567;all P<0.05).Multivariate logistic regression analysis showed that advanced age,low WBC,ALB and Hb levels and high NLR and PLR were the risk factors for nosocomial infection in maintenance hemodialysis patients with chronic renal failure(P<0.05).Predictive analysis showed that the area under the curve(AUC)of risk factors was 0.910,the sensitivity was 93.8%,and the specificity was 88.0%.Conclusions For patients with chronic renal failure undergoing maintenance hemodialysis,advanced age,poor nutritional status,and reduced WBC could increase the risk of nosocomial infection.The combination of the above risk factors had a high predictive value for the occurrence of nosocomial infection.