替加环素致凝血功能异常预测模型构建

Predictive model for coagulation disorders induced by tigecycline

目的研究替加环素对患者凝血功能的影响,分析危险因素,并建立其致凝血异常的预测模型。方法对2020年1月至2022年10月使用替加环素患者进行回顾性分析,运用Logistic回归分析找出替加环素致凝血异常的独立危险因素,建立预测模型,并通过受试者工作特征(ROC)曲线和Hosmer-Lemeshow拟合优度检验对其效果进行综合评价。结果187例患者凝血功能异常发生率35.83%。异常组患者在出血事件方面明显高于正常组患者(37.31%vs 15.83%,P=0.001),主要集中在消化道方面。替加环素使用疗程(OR=3.56,95%CI:1.325~9.569,P=0.012)、日剂量(OR=2.772,95%CI:1.324~5.802,P=0.007)是凝血功能异常的独立危险因素;血红蛋白水平(OR=3.519,95%CI:1.584~7.819,P=0.002)是凝血异常的保护因素。构建替加环素致凝血异常的预测模型,Logit(P)=-2.863+1.258X2+1.270X3+1.019X4,当Logit(P)>0.3604时,提示替加环素导致凝血异常风险高。结论替加环素致凝血异常发生率较高,对血红蛋白水平较低、长疗程、大剂量使用的患者,应加强监测,确保用药安全。

Objective To determine the influence factors of tigecycline on the coagulation of patients,and to establish a prediction model for the coagulation disorders.Methods Patients who used tigecycline from January 2020 to October 2022 were retrospectively analyzed.The independent risk factors for coagulation disorders induced by tigecycline were identified with Logistic regression analysis.Then we established a prediction mode,whose effect was comprehensively evaluated by the receiver operating characteristic(ROC)curve and Hosmer-Lemeshow test.Results Abnormal coagulation occurred in 187(35.83%)patients.Bleeding of patients in the abnormal group was significantly higher than that in the normal group(37.31%vs 15.83%,P=0.001),mainly in the digestive tract.The treatment course(OR=3.56,95%CI:1.325~9.569,P=0.012),and daily dose(OR=2.772,95%CI:1.324~5.802,P=0.007)were independent risk factors.The hemoglobin level(OR=3.519,95%CI:1.584-7.819,P=0.002)was the protective factor.The prediction model of coagulation abnormalities caused by tigecycline was set up:Logit(P)=-2.863+1.258X2+1.270X3+1.019X4.When Logit(P)was over 0.3604,higher risks of coagulation abnormalities due to tigecycline were suggested.Conclusion Tigecycline may increase the incidence of coagulation abnormalities especially among patients with low hemoglobin level,long treatment course and high dose of tigecycline.