前列腺增生症患者尿流动力学检查后尿路感染相关因素分析及预测列线图模型的构建

The analysis of relative factors of urinary tract infection in patients with prostatic hyperplasia following urodynamic study and the establishment of its a nomogram predictive for model predicting urinary tract infection in patients with prostatic hyperplasia following urodynamic study

目的本研究旨在确立前列腺增生症患者尿流动力学检查后尿路感染的临床危险因素,并建立预测尿路感染风险的列线图模型。方法以2014年1月至2019年9月间在我院完成尿流动力学检查的540名前列腺增生症患者为研究对象,采用多因素Logistic回归分析方法筛选临床危险因素,并建立预测前列腺增生症患者尿流动力学检查后尿路感染发生概率的列线图模型。通过受试者工作特征(ROC)曲线和重复1000次Bootstrap自抽样方法检验模型区分度,绘制校准曲线来评价模型一致性。结果多因素Logistic回归分析显示年龄≥65岁、糖尿病、存在尿路感染史以及膀胱出口梗阻(均P<0.05)是前列腺增生症患者尿流动力学检查后尿路感染发生的危险因素。运用ROC曲线及重复1000次Bootstrap自抽样方法计算的一致性指数(C?index)分别为0.754及0.735,表明模型具有良好的区分度;校正曲线接近45度斜线的理想曲线,提示该模型具有良好一致性。结论基于上述4个危险因素构建的列线图具有良好的预测性能,是预测前列腺增生症患者尿流动力学检查后尿路感染的一种可靠、简便的临床工具。

Objective To determine risk factors of urinary tract infection(UTI) in patients with prostatic hyperplasia following urodynamic study(UDS), and develop a nomogram model for individual UTI risk prediction in patients with prostatic hyperplasia after UDS. Methods A total of 540 patients with prostatic hyperplasia, who underwent UDS in Wenzhou Central Hospital from January 2014 to September 2019 were analyzed in the study. Multivariate logistic regression analysis was performed to identify independent risk factors and construct a nomogram for predicting the UTI rates in patients with prostatic hyperplasia following UDS. Results Logistic regression analysis showed that age≥65 years, diabetes, history of UTI, and bladder outlet obstruction were independent risk factors of UTI in patients with prostatic hyperplasia following UDS(P<0.05). Internal validation showed that the model had good discrimination of the model,and with the initial concordance index(C-index)of nomogram was 0.754, and C-index of nomogram was 0.735 after 1 000 times of internal validation. The consistency of the nomogram was good according to the calibration curves. Conclusions This nomogram based on the four risk factors with good predictive performance is a reliable and simple clinical instrument to predict UTI in patients with prostatic hyperplasia following UDS.