老年髋部骨折患者发生尿路感染风险预测模型的构建和验证

Construction of risk prediction model of urinary tract infection in elderly patients with hip fracture and its verification

目的 探究老年髋部骨折患者发生尿路感染(UTI)的危险因素,构建并验证其风险预测模型。方法 回顾性分析2017年1月-2020年10月在天津市某三级甲等医院就诊的老年髋部骨折患者673例,按照是否发生UTI将其分为UTI与非UTI组。收集老年髋部骨折患者的临床资料,采用logistic多因素回归分析筛选其发生尿路感染的独立危险因素;采用ROC曲线下面积(AUC)、拟合优度检验和校准图以及DCA决策曲线图分析模型的预测效果。结果 老年髋部骨折患者UTI发生率为17.68%。Logistic回归分析显示:糖尿病、留置尿管时间>3 d、年龄、性别和电解质失衡为老年髋部骨折患者发生UTI的独立危险因素。基于上述5个危险因素建立的列线图,AUC为0.729,拟合优度检验χ^(2)=10.942,P=0.205。结论 本研究构建的logistics回归模型对老年髋部骨折患者发生UTI具有一定的预测价值,列线图能够初步预测老年髋部骨折患者发生尿路感染的风险。

Objective To explore the risk factors of urinary tract infection(UTI) in elderly patients with hip fracture, and to construct and verify its risk prediction model. Methods A retrospective analysis was performed on 673 elderly hip fracture patients in a tertiary A hospital in Tianjin from January 2017 to October 2020, and they were divided into urinary tract infection group and non-urinary tract infection group according to whether or not UTI occurred. The clinical data of patients were collected, logistic multivariate regression analysis was used to screen the independent risk factors for UTI in elderly hip fracture patients, and the area under the ROC curve(AUC), goodness-of-fit test, calibration chart, and DCA decision curve chart were used to analyze the prediction effect of the model. Results The incidence of UTI in elderly patients with hip fracture was 17.68%;logistic regression analysis showed that diabetes, indwelling catheter time >3 d, age, gender, and electrolyte imbalance were independent risk factors for UTI in elderly patients with hip fracture.Based on the nomogram established by the above five risk factors AUC was 0.729, and the goodness of fit test χ~2=10.942(P=0.205). Conclusion The logistics regression model has certain predictive value for elderly hip fracture patients, and this nomogram graph can preliminarily predict the risk of UTI in elderly hip fracture patients.