肝硬化腹水并发自发性细菌性腹膜炎的临床危险因素分析及诊断模型构建

Analysis of clinical risk factors and construction of diagnostic model for cirrhotic ascites complicated with spontaneous bacterial peritonitis

目的 分析肝硬化腹水并发自发性细菌性腹膜炎(SBP)的危险因素,构建诊断模型以更好地指导临床治疗。方法 回顾性纳入2020年1月至2022年12月于该院住院治疗的206例肝硬化腹水患者为研究对象,根据患者住院期间是否发生SBP,将其分为SBP组109例(52.91%)和非SBP组97例(47.09%)。通过电子病历系统收集患者的临床资料及实验室检查指标。采用单因素分析和多因素logistic回归分析肝硬化腹水患者发生SBP的独立危险因素,并建立logistic回归模型,通过受试者工作特征(ROC)曲线下面积(AUC)验证模型的诊断效能。结果 SBP组WBC、PLT/WBC、中性粒细胞百分比(NEUT%)、总胆红素(TBIL)、清蛋白(ALB)、清蛋白-胆红素(ALBI)评分、血小板-清蛋白-胆红素(PALBI)评分与非SBP组比较,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示WBC(OR=6.165,95%CI:2.459~17.145)、NEUT%(OR=2.423,95%CI:1.185~5.055)、TBIL(OR=2.850,95%CI:1.402~5.896)、ALB(OR=0.346,95%CI:0.137~0.831)、ALBI评分(OR=2.619,95%CI:1.232~5.674)是肝硬化腹水并发SBP的独立影响因素。建立的诊断模型具有较好的诊断效能,Kappa值为0.441,模型的AUC为0.821(95%CI:0.764~10.877),当预测最佳截断(cut-off)值为0.665时,诊断模型的灵敏度为0.866,特异度为0.688,Youden指数为0.554。结论 WBC、NEUT%、TBIL、ALB、ALBI评分是肝硬化腹水并发SBP的独立危险因素,由此建立的诊断模型对肝硬化腹水并发SBP具有较高的诊断准确率,可为临床早期诊断SBP提供参考。

Objective To analyze the risk factors of cirrhotic ascites complicated with spontaneous bacterial peritonitis(SBP),and construct a diagnostic model to better guide clinical treatment.Methods A total of 206 patients with cirrhosis ascites who were hospitalized in the hospital from January 2020 to December 2022 were retrospectively included in the study.According to whether SBP occurred during hospitalization,they were divided into the SBP group(109 cases,52.91%)and non-SBP group(97 cases,47.09%).The clinical data and laboratory test indicators of the patients were collected through the electronic medical record system.Univariate analysis and multivariate logistic regression were used to analyze the independent risk factors of SBP in patients with cirrhotic ascites,and a logistic regression model was established.The diagnostic efficacy of the model was verified by the area under the receiver operating characteristic(ROC)curve(AUC).Results There were significant differences in white blood cell count(WBC),platelet to white blood cell ratio(PLT/WBC),neutrophil percentage(NEUT%),total bilirubin(TBIL),albumin(ALB),albumin-bilirubin(ALBI)score and platelet-albumin-bilirubin(PALBI)score between the SBP group and non-SBP group(P<0.05).Multivariate logistic regression analysis showed that WBC(OR=6.165,95%CI:2.459-17.145),NEUT%(OR=2.423,95%CI:1.185-5.055),TBIL(OR=2.850,95%CI:1.402-5.896),ALB(OR=0.346,95%CI:0.137-0.831),ALBI score(OR=2.619,95%CI:1.232-5.674)were independent influencing factors of SBP in cirrhotic ascites.The established diagnostic model had good diagnostic efficacy.The Kappa value was 0.441,and the AUC of the model was 0.821(95%CI:0.764-10.877).When the cut-off value was 0.665,the sensitivity of the diagnostic model was 0.866,the specificity was 0.688,and the Youden index was 0.554.Conclusion WBC,NEUT%,TBIL,ALB and ALBI score are independent risk factors for SBP in cirrhotic ascites.The diagnostic model established by this method has a high diagnostic accuracy for SBP in cirrhotic ascites,which could provide a reference for early clinical diagnosis of SBP.