肺癌化疗患者发生导管相关性血流感染的影响因素及其风险预测列线图模型构建

Influencing Factors of Catheter-Related Bloodstream Infection in Patients with Lung Cancer Undergoing Chemotherapy and Construction of Nomogram Model for Predicting Its Risk

目的 探讨肺癌化疗患者发生导管相关性血流感染(CRBSI)的影响因素,构建其风险预测列线图模型并进行验证。方法 选取2010年1月至2022年11月盐城市第三人民医院收治的肺癌化疗患者1 169例为研究对象,按照6∶4的比例将其分为建模集(701例)及验证集(468例)。收集所有患者的临床资料,根据是否发生CRBSI将建模集患者分为发生组和未发生组。采用多因素Logistic回归分析探讨肺癌化疗患者发生CRBSI的影响因素;采用R 4.1.2软件包及rms程序包建立肺癌化疗患者发生CRBSI的风险预测列线图模型;采用Hosmer-Lemeshoe拟合优度检验评价该列线图模型的拟合程度;绘制校准曲线以评估该列线图模型预测建模集及验证集肺癌化疗患者发生CRBSI的效能;采用ROC曲线分析该列线图模型对建模集及验证集肺癌化疗患者发生CRBSI的预测价值。结果 建模集701例肺癌化疗患者中,发生CRBSI 71例(10.13%),未发生CRBSI 630例(89.87%)。两组肿瘤分期、营养状况、有糖尿病者占比、化疗次数、有重症监护病房住院史者占比、导管维护时间延长者占比、导管移动者占比、导管留置时间、穿刺次数比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,糖尿病、化疗次数、重症监护病房住院史、导管维护时间延长、导管移动、导管留置时间、穿刺次数是肺癌化疗患者发生CRBSI的影响因素(P<0.05)。基于多因素Logistic回归分析结果,构建肺癌化疗患者发生CRBSI的风险预测列线图模型。Hosmer-Lemeshoe拟合优度检验结果显示,在建模集中该列线图模型的拟合程度较好(χ^(2)=8.905,P=0.350),在验证集中该列线图模型的拟合程度较好(χ^(2)=8.693,P=0.365)。校准曲线分析结果显示,该列线图模型预测建模集和验证集肺癌化疗患者的CRBSI发生率与实际发生率基本吻合。ROC曲线分析结果显示,该列线图模型预测建模集和验证集肺癌化疗患者发生CRBSI的AUC分别为0.859[95%CI(0.804,0.914)]、0.876[95%CI(0.813,0.940)]。结论 糖尿病、化疗次数≥5次、有重症监护病房住院史、导管维护时间延长、导管移动、导管留置时间≥30 d、穿刺次数≥2次是肺癌化疗患者发生CRBSI的危险因素,基于上述因素构建的列线图模型对肺癌化疗患者发生CRBSI具有一定预测价值。

Objective To explore the influencing factors of catheter-related bloodstream infection(CRBSI)in patients with lung cancer undergoing chemotherapy,and construct a nomogram model for predicting its risk and validate it.Methods A total of 1169 lung cancer patients undergoing chemotherapy admitted to Yancheng Third People's Hospital from January 2010 to November 2022 were selected as the research subjects.The patients were divided into modeling set(70 cases)and validation set(468 cases)in a ratio of 6:4.Clinical data of patients were collected,the patients in modeling set were divided into occurrence group and non-occurrence group based on whether CRBSI occurred.Multivariate Logistic regression analysis was used to analyze the influencing factors of CRBSI in patients with lung cancer undergoing chemotherapy.The nomogram model for predicting the risk of CRBSI in patients with lung cancer undergoing chemotherapy was constructed by using the R 4.1.2 software package and rms package.Hosmer-Lemeshoe goodness of fit test was used to evaluate the fitting degree of the nomogram model.Calibration curve was drawn to evaluate the effectiveness of the nomogram model for predicting CRBSI in patients with lung cancer undergoing chemotherapy in modeling set and validation set,and the ROC curve was used to analyze the predictive value of the nomogram model for CRBSI in patients with lung cancer undergoing chemotherapy in modeling set and validation set.Results Among 701 lung cancer patients undergoing chemotherapy in the modeling set,71(10.13%)patients had CRBSI,630(89.87%)patients had no CRBSI.There were significant differences in tumor stage,nutritional status,the proportion of patients with diabetes,the number of chemotherapy,the proportion of patients with a history of hospitalization in intensive care unit,the proportion of patients with prolonged catheter maintenance time,the proportion of patients with catheter movement,catheter retention time,and the number of punctures between the two groups(P<0.05).Multivariate Logistic regression analysis showed that diabetes,the number of chemotherapy,history of hospitalization in intensive care unit,prolonged catheter maintenance time,catheter movement,catheter retention time,and the number of punctures were the influencing factors of CRBSI in patients with lung cancer undergoing chemotherapy(P<0.05).The nomogram model for predicting CRBSI in patients with lung cancer undergoing chemotherapy was constructed based on the results of multivariate Logistic regression analysis.The results of Hosmer-Lemeshoe goodness of fit test showed that the nomogram model fit well in modeling set(χ^(2)=8.905,P=0.350)and in validation set(χ^(2)=8.693,P=0.365).The results of calibration curve analysis showed that the incidence of CRBSI in patients with lung cancer undergoing chemotherapy predicted by the nomogram model was basically consistent with the actual incidence of CRBSI in patients with lung cancer undergoing chemotherapy in modeling set and validation set.The results of ROC curve analysis showed that the AUC of the nomogram model for predicting CRBSI in patients with lung cancer undergoing chemotherapy in modeling set and validation set was 0.859[95%CI(0.804,0.914)],0.876[95%CI(0.813,0.940)],respectively.Conclusion Diabetes,the number of chemotherapy≥5,history of hospitalization in intensive care unit,prolonged catheter maintenance time,catheter movement,catheter retention time≥30 d,and the number of punctures≥2 are the risk factors of CRBSI in patients with lung cancer undergoing chemotherapy.The nomogram model constructed based on the above factors has a certain predictive value for CRBSI in patients with lung cancer undergoing chemotherapy.