肝移植术后腹腔感染危险因素及预测模型建立

Risk factors for postoperative abdominal infection in liver transplantation patients and establishment of prediction model

目的探讨肝移植术后腹腔感染的危险因素,并建立风险预测模型。方法回顾性分析2019年2月-2020年10月河北医科大学第三医院接受肝移植治疗的患者110例,分析感染病原菌分布特点及术后腹腔感染率,单因素及多因素Logistic回归分析肝移植患者术后腹腔感染的危险因素,并依据Logistic回归分析结果建立风险预测模型,Hosmer-Lemeshow检验评估模型拟合度,受试者工作特征曲线(ROC)分析回归模型的预测价值。结果110例肝移植患者发生术后腹腔感染26例,感染率为23.64%。感染患者共检出病原菌38株,其中革兰阳性菌20株占52.63%,革兰阴性菌14株占36.84%,真菌4株占10.53%;Logistic回归分析结果,终末期肝病模型(MELD)评分≥20分、Child-Pugh评分≥10分、手术时间≥12h、术中输血量≥3000ml、引流管置管时间≥48h、重症监护室(ICU)住院时长≥6d是肝移植患者术后腹腔感染的独立危险因素;根据Logistic回归结果建立风险预测模型经Hosmer-Lemeshow检验拟合度较高(χ^(2)=7.596,P=0.474),ROC分析结果,模型预测肝移植术后腹腔感染的曲线下面积(AUC)为0.891。结论肝移植患者术后腹腔感染发生率较高,主要感染病原菌为革兰阳性菌;Logistic回归模型对肝移植患者术后腹腔感染具有良好的预测效果,临床可针对上述危险因素进行重点监测并实施相关干预措施以降低患者术后腹腔感染发生率,提高患者预后。

OBJECTIVE To explore the risk factors for postoperative abdominal infection in the liver transplantation patients and establish the risk prediction model.METHODS A total of 110patients who received liver transplantation in the Third Hospital of Hebei Medical University from Feb 2019to Oct 2020were retrospectively analyzed,the distribution of pathogens and incidence of postoperative abdominal infection were observed,univariate analysis and multivariate logistic regression analysis were performed for risk factors for the postoperative abdominal infection,the risk prediction model was established based on the result of logistic regression analysis,the fitting degree of the model was evaluated by Hosmer-Lemeshow test,and the predictive value of the regression model was analyzed by means of receiver operating characteristic(ROC)curve.RESULTS Among the 110liver transplantation patients,26had postoperative abdominal infection,with the infection rate 23.64%.Totally 38strains of pathogens were isolated from the patients with infection,20(52.63%)of which were gram-positive bacteria,14(36.84%)were gram-negative bacteria,and 4(10.53%)were fungi.The result of logistic regression analysis showed that score of model for end-stage liver disease(MELD)no less than 20points,Child-Pugh score no less than 10 points,operation duration no less than 12hours,intraoperative blood transfusion volume no less than 3000ml,drainage tube indwelling time no less than 48hours and length of intensive care unit(ICU)stay no less than 6 days were independent risk factors for the postoperative abdominal infection in the liver transplantation patients.The result of Hosmer-Lemeshow test showed that the fitting degree of the risk prediction model that was established based on the result of logistic regression analysis was high(χ^(2)=7.596,P=0.474).ROC curve analysis indicated that the area under curve(AUC)was 0.891in prediction of the postoperative abdominal infection.CONCLUSIONThe incidence of postoperative abdominal infection is high among the liver transplantation patients,the gram-positive bacteria are dominant among the pathogens causing the infection.Logistic regression model can achieve favorable effect on prediction of postoperative abdominal infection.It is necessary for the hospital to focus on monitoring of the risk factors and take targeted intervention measures so as to reduce the incidence of postoperative abdominal infection and improve the prognosis.