重症颅脑损伤多重耐药菌肺部感染危险因素及预测模型建立

Risk factors for multidrug-resistant organisms pulmonary infections in patients with severe craniocerebral injury and establishment of prediction model

目的 探讨和分析重症颅脑损伤患者发生多重耐药菌(MDRO)肺部感染的危险因素,并建立与验证风险预测模型。方法 回顾性收集2018年1月—2023年12月赣州市人民医院发生肺部感染的重症颅脑损伤患者430例的临床资料,按照7:3比例将其随机分为建模组301例和验证组129例,利用建模组数据建立Logistic回归模型,根据β值对危险因素赋分并建立风险预测模型,通过绘制重症颅脑损伤患者MDRO肺部感染风险预测的受试者工作特征(ROC)曲线对模型效能进行验证。结果 Logistic回归分析显示,年龄≥65岁、机械通气≥7 d、气管切开、住院时间≥30 d、抗菌药物使用≥14 d及昏迷是影响建模组重症颅脑损伤患者发生MDRO肺部感染的危险因素(P<0.05),对应的风险预测模型中,分别被赋予2、1、2、2、1、1分。风险模型在建模组中的ROC曲线下面积(AUC)为0.776 (95%CI:0.659~0.893,P <0.001),在验证组中AUC为0.760 (95%CI:0.643~0.877,P<0.001)。结论 年龄≥65岁、机械通气≥7 d、气管切开、住院时间≥30 d、抗菌药物使用≥14 d及昏迷均是重症颅脑损伤患者发生MDRO肺部感染的危险因素;构建的风险评估体系对于包括建模组与验证组中的所有重症颅脑损伤患者而言都具备良好的预测效果,可提前发现潜在的高风险群体并优化临床诊治策略。

OBJECTIVE To explore the risk factors for multidrug-resistant organisms(MDROs)pulmonary infec-tions in the patients with severe craniocerebral injury,establish and validate the risk prediction model.METHODS A total of 430 craniocerebral injury patients with pulmonary infection who were treated in Ganzhou People's Hos-pital from Jan 2018 to Dec 2023 were enrolled in the study and were randomly divided into the modeling group with 301 cases and the validation group with 129 cases in a 7∶3 ratio.The logistic regression model was estab-lished based on the modeling data,the risk factors were assigned for score based onβvalue.The efficiency of the model in prediction of risk of MDROs pulmonary infection was validated by means of receiver operating character-istic(ROC)curves.RESULTS The result of logistic regression analysis showed that no less than 65 years of age,mechanical ventilation duration no less than 7 days,tracheotomy,length of hospital stay no less than 30 days,use of antibiotics for no less than 14 days and coma were the risk factors for the MDROs pulmonary infections in the craniocerebral injury patients(P<0.05).2,1,2,2,1 and 1 point were respectively scored for the corresponding risk prediction model.The area under ROC curve(AUC)of the risk model was 0.776(95%CI:0.659-0.893,P<0.001)in the modeling group,0.760(95%CI:0.643-0.877,P<0.001)in the validation group.CONCLUSION The no less than 65 years of age,mechanical ventilation duration no less than 7 days,tracheotomy,length of hospital stay no less than 30 days,use of antibiotics for no less than 14 days and coma are the risk factors for the MDROs pulmonary infections in the patients with severe craniocerebral injury.The risk assessment system has favorable predictive effect for all the severe craniocerebral injury patients in both the modeling group and the validation group and may facilitate the identification of high-risk population and optimize the clinical diagnosis and treatment strate-gies.