胃癌根治术后肺部感染早期预警评分表的构建

Construction of early warning score for pulmonary infection after radical gastrectomy for gastric cancer

目的:构建胃癌根治术后肺部感染早期预警评分表,及早识别高危人群并给予干预。方法:选取2015年6月—2020年12月在我院接受胃癌根治术的病人221例,通过单因素分析及多因素二元Logistic回归分析确定病人术后肺部感染的独立危险因素并建立预测模型,采用Hosmer-Lemeshow检验和受试者工作特征曲线评价模型效能。依据约登指数确定各独立危险因素截断值,构建胃癌术后肺部感染早期预警评分表。结果:221例病人中,肺部感染发生率为8.14%,术后肺部感染的独立危险因素包括咳嗽咳痰困难(3分)、吸烟史(3分)、C反应蛋白/清蛋白比值(CAR)≥2.71(3分)、最高体温≥37.8℃(2分)。模型的Hosmer-Lemeshow检验显示有较好的拟合优度(χ2=2.77,P=0.95),本研究构建的早期预警评分表工作特征曲线下面积(AUC)为0.97,95%CI[0.92,1.00],P<0.001,依据评分的截断值将221例病人进行风险分级,0~7分为低风险组,8~11分为高风险组,两组肺部感染率比较差异具有统计学意义(χ2=112.29,P<0.001)。结论:本研究所构建的胃癌根治术后肺部感染早期预警评分表所纳入因素收集简便,预测结果科学有效,能够早期识别高危人群。

Objective:To construct an early warning score for pulmonary infection after radical gastrectomy for gastric cancer to identify high-risk groups early and provide intervention.Methods:A total of 221 patients who underwent a radical operation for gastric cancer in our hospital from June 2015 to December 2020 were selected.Univariate and multivariate binary logistic regression analyses were used to determine the independent risk factors of postoperative pulmonary infection and establish the prediction model.The Hosmer-Lemeshow test and the receiver operator characteristic curve(ROC)were used to evaluate the model’s effectiveness.The cut-off value of each independent risk factor was determined according to the Youden index,and an early warning score of pulmonary infection after gastric cancer surgery was constructed.Results:Among the 221 patients,the incidence of pulmonary infection was 8.14%.The independent risk factors for postoperative pulmonary infection included difficulty in coughing and expectorating(3 points),smoking history(3 points),C-reactive protein/albumin ratio(CAR)≥2.71(3 points),the highest body temperature≥37.8 ℃(2 points).The Hosmer-Lemeshow test of the model showed good goodness of fit(χ2=2.77,P=0.95);the area under the curve(AUC)of the working characteristic of the early warning score constructed in this study was 0.97,95%CI[0.92~1.00],P<0.001.The 221 patients were classified according to the cut-off value of score as low-risk group(0-7 points)and high-risk group(8-11 points),and there was a statistically significant difference in pulmonary infection between the two groups(χ2=112.29,P<0.001).Conclusions:The factors included in the early warning score for pulmonary infection after radical gastrectomy constructed in this study were easy to collect,and the prediction results were scientific and effective,which could identify the high-risk groups in the early stage.