医院获得性肺部感染引发脓毒症的风险评分系统的建立及验证

Establishment and validation of risk assessment scoring system for sepsis induced by hospital-acquired pulmonary infections

目的建立住院患者医院肺部感染引发脓毒症的风险评分系统,为医院肺部感染相关脓毒症的防控提供参考依据。方法选取某院2017年1月1日-12月31日395例医院获得性肺部感染住院患者作为研究对象,构建logistic回归模型进行影响因素分析,建立风险评分系统,利用ROC曲线评价模型的预测效果。结果 395例医院获得性肺部感染发生脓毒症119例,占30.13%;构建Logistic回归分析显示,静脉血栓栓塞症(VTE)评分≥5分、有慢性肺外基础疾病、曾住ICU、呼吸道侵袭性操作是医院获得性肺部感染患者发生脓毒症的独立影响因素。风险评分系统包括:VTE评分≥5分、有慢性肺外基础疾病、曾住ICU、呼吸道侵袭性操作。分值≥3分为高危人群;风险评分系统模型评价显示,建模组风险评分ROC曲线下面积为0.831,灵敏度为56.2%,特异度为95.1%,约登指数51.3%;验证组ROC曲线下面积为0.748,灵敏度为36.7%,特异度为95.9%,约登指数32.6%。结论建立并验证了住院患者医院肺部感染引发脓毒症的风险评分系统,该风险评估系统有助于监测高危患者,降低脓毒症的发生。

OBJECTIVE To establish the risk assessment scoring system for sepsis induced by hospital-acquired pulmonary infections in hospitalized patients so as to provide guidance for prevention and control of nosocomial pulmonary infection-associated sepsis.METHODS A total of 395 patients with hospital-acquired pulmonary infections who were hospitalized from Jan 1,2017 to Dec 31,2017 were recruited as the study objects.Logistic regression model was constructed for analysis of influencing factors,the risk assessment scoring system was established,and the predictive effect of the model was evaluated by using ROC curve.RESULTS Of the 395 patients with hospitalacquired pulmonary infections,119 had sepsis,accounting for 30.13%.The logistic regression analysis showed that the venous thromboembolism（VTE）score no less than 5 points,chronic extra-pulmonary underlying disease,ICU stay and respiratory invasive operation were the independent influencing factors for the sepsis in the patients with hospital-acquired pulmonary infections.The risk assessment scoring system comprised the VTE score no less than 5 points,chronic extra-pulmonary underlying disease,ICU stay and respiratory invasive operation.The people with the score no less than 3 points were the high-risk population.The risk assessment scoring system indicated that the area under ROC curve of the establishment group was 0.831,the sensitivity 56.2%,the specificity95.1%,the Youden index 51.3%;the area under ROC curve of the validation group was 0.748,the sensitivity36.7%,the specificity 95.9%,the Youden index 32.6%.CONCLUSION The establishment and validation of the risk assessment scoring system for sepsis induced by hospital-acquired pulmonary infections in the hospitalized patients may facilitate the monitoring of the high-risk patients and reduce the incidence of sepsis.