老年PICC患者并发CRBSI的危险因素分析及相关预测模型构建

Analysis of risk factors for CRBSI in elderly PICC patients and construction validation of related predictive models

目的探究老年经外周静脉置入中心静脉导管(PICC)患者并发导管相关性血流感染(CRBSI)的危险因素及相关预测模型。方法选取2016年1月—2021年12月武汉市红十字会医院475例行PICC的老年患者,统计置管期间或拔管48 h后CRBSI发生情况,根据是否发生CRBSI分为CRBSI组和非CRBSI组,比较两组临床资料,分析CRBSI发生的影响因素,根据影响因素构建CRBSI的Nomogram预测模型,并对预测模型进行内部验证。结果本研究老年PICC患者CRBSI发生率为16.84%;CRBSI组年龄、糖尿病占比、成功置管穿刺次数≥2次占比、导管留置时间≥30 d占比、导管移动占比、换药频次≥7 d占比、免疫功能低下占比及CRP/Alb水平高于非CRBSI组,白细胞计数(WBC)、25羟维生素D3[25(OH)D_(3)]水平、成年人健康自我管理能力测评量表(AHSMSRS)评分低于非CRBSI组(P<0.05);年龄、糖尿病、成功置管穿刺次数、导管留置时间、导管移动、换药频次、免疫功能、WBC、25(OH)D_(3)、CRP/Alb水平、AHSMSRS评分均为老年PICC患者并发CRBSI的影响因素(P<0.05);根据Logistic多因素分析获取的影响因素构建CRBSI的Nomogram预测模型,该预测模型的一致性指数(C-index)为0.894,具有良好的区分度,决策曲线(DCA)显示该预测模型具有良好的临床效用。结论老年PICC患者并发CRBSI的影响因素包括年龄、糖尿病、成功置管穿刺次数、导管留置时间等多方面,根据影响因素构建Nomogram预测模型能直观预测CRBSI发生风险。

Objective To explore the risk factors and related prediction models of catheter related blood stream infection(CRBSI)in elderly patients with peripherally inserted central catheter(PICC).Methods A total of 475 elderly patients who underwent PICC placement in Wuhan Red Cross Society Hospital from January 2016 to December 2021 were selected,and the occurrence of CRBSI during PICC placement or 48 h after extubation of PICC was counted.Patients were divided into CRBSI and non-CRBSI groups according to their CRBSI occurrence.Clinical data were compared between the two groups,and the influencing factors of CRBSI occurrence were analyzed.A Nomogram predictive model of CRBSI was constructed based on the influencing factors,and internal validation of the predictive model was performed.Results The incidence of CRBSI in elderly PICC patients in this study was 16.84%.In the CRBSI group,the age,percentage of diabetes,percentage of successful PICC placement≥2 times,percentage of PICC retention time≥30 days,percentage of PICC extubation time,percentage of drug change frequency≥7 days,percentage of low immune patients and CRP/Alb level were higher in the CRBSI group than in the non-CRBSI group.White blood cell count(WBC),25-hydroxy vitamin[25(OH)D_(3)]levels and the rating scale of health self-management skill for adults scores(AHSMSRS)were lower than those in the non-CRBSI group(P<0.05).Age,diabetes,the number of successful catheterization,catheter indwelling time,catheter movement,dressing change frequency,immune function,WBC,25(OH)D_(3),CRP/Alb levels,and AHSMSRS scores were all the influencing factors of CRBSI in elderly PICC patients(P<0.05).The Nomogram predictive model of CRBSI was constructed based on the influencing factors obtained by logistic multifactor analysis.The consistency index(C-index)of this predictive model was 0.894,which had good discrimination,and the decision curve analysis(DCA)showed that this predictive model had good clinical utility.Conclusion The risk factors for CRBSI in elderly PICC patients include age,diabetes,successful times of PICC placement,the retention time of PICC,etc.Constructing a Nomogram predictive model constructed based on these influencing factors can provide an intuitive prediction of the risk of CRBSI.