高龄肺癌患者化疗期间院内肺部感染风险模型的构建与验证

Construction and validation of a risk model for hospital acquired pulmonary infection in elderly lung cancer patients during chemotherapy

目的分析高龄肺癌患者化疗期间院内肺部感染的危险因素,并构建预测模型,个体化指导临床护理工作。方法采用便利抽样法,收集2021年1月—2022年12月郑州大学第一附属医院的405例行化疗的高龄肺癌患者的临床病例资料,将2021年1—12月的226例患者作为建模组,将2022年1—12月的179例患者作为验证组。在建模组中,按照是否发生院内肺部感染分为院内肺部感染组及无院内肺部感染组。采用单因素分析和多因素Logistics回归分析确定高龄肺癌患者化疗期间发生院内肺部感染的危险因素,并根据多因素分析结果构建高龄肺癌患者化疗期间院内肺部感染风险的预测模型。通过受试者工作特征曲线(ROC)下面积评估预测模型的预测效能,绘制校准图进行一致性检验,并使用预测模型在验证队列中验证,评估预测模型预测效能。结果建模组院内肺部感染的发生率为14.6%(33/226)。多因素Logistic回归分析结果显示,基础疾病、TNM分期、中性粒细胞减少和侵入性操作是高龄肺癌化疗患者发生院内肺部感染的危险因素(P<0.05)。根据此结果构建预测模型,预测模型在建模组的ROC曲线下面积为0.832(95%CI:0.764~0.900),在验证组中的ROC曲线下面积为0.759(95%CI:0.695~0.824)。建模组与验证组的校正曲线显示预测结果与实际结果有较好的重合度。结论基础疾病、中性粒细胞降低、侵入性操作、肿瘤中晚期是高龄肺癌化疗患者院内肺部感染的危险因素。对于高风险患者,要及早进行个体化干预,降低院内肺部感染发生率。

Objective To analyze the risk factors for hospital acquired pulmonary infections in elderly lung cancer patients during chemotherapy,and construct a prediction model to provide personalized guidance for clinical nursing work.Methods Using convenience sampling,clinical case data of 405 elderly lung cancer patients who underwent chemotherapy at the First Affiliated Hospital of Zhengzhou University from January 2021 to December 2022 were collected.A total of 226 patients from January to December 2021 were selected as the modeling group,and 179 patients from January to December 2022 were selected as the validation group.In the modeling group,the patients were divided into two groups based on whether or not they had hospital acquired pulmonary infection,including the hospital acquired pulmonary infection group and the non-hospital acquired pulmonary infection group.Single factor analysis and multivariate Logistic regression analysis were used to determine the risk factors for hospital acquired pulmonary infection in elderly lung cancer patients during chemotherapy.A risk prediction model for hospital acquired pulmonary infection in elderly lung cancer patients during chemotherapy was constructed based on the results of multivariate analysis.The area under the receiver operating characteristic(ROC)curve was used to evaluate the predictive performance of the prediction model,and a calibration map was drawn for consistency testing.The prediction model was validated in the validation group to evaluate its predictive performance.Results The incidence of hospital acquired pulmonary infection in the modeling group was 14.6%(33/226).The results of multivariate Logistic regression analysis showed that basic diseases,tumor-node-metastasis(TNM)staging,neutropenia,and invasive procedures were risk factors for hospital acquired pulmonary infections in elderly lung cancer patients undergoing chemotherapy(P<0.05).Based on this result,a prediction model was constructed,with an area under the ROC curve of 0.832[95%CI(0.764,0.900)]in the modeling group and 0.759[95%CI(0.695,0.824)]in the validation group.The calibration curves of the modeling and validation groups showed a good coincidence between the predicted results and the actual results.Conclusions Basic diseases,neutropenia,invasive procedures,and advanced stages of tumors are risk factors for hospital acquired pulmonary infections in elderly lung cancer patients undergoing chemotherapy.For high-risk patients,individualized intervention should be carried out as soon as possible to reduce the incidence of hospital acquired pulmonary infection.