胶质瘤术后继发鲍曼不动杆菌颅内感染的风险预测分析

Risk Prediction of Secondary Intracranial Infection of Acinetobacter Baumannii in Glioma Patients After Surgery

目的探讨胶质瘤手术患者术后继发鲍曼不动杆菌颅内感染的风险因素并构建预测模型。方法收集行胶质瘤手术治疗且术后继发颅内感染90例患者的临床资料,对病原菌进行检测,根据检测结果分为鲍曼不动杆菌感染组(n=32)和非鲍曼不动杆菌感染组(n=58),分析胶质瘤手术患者术后继发鲍曼不动杆菌颅内感染危险因素,应用多元Logistic回归分析筛选独立危险因素并建立预测模型,绘制受试者工作特征(ROC)曲线检验预测模型效能。结果两组术后脑脊液漏、术前预防用抗生素、围术期使用激素、低蛋白血症方面比较差异有统计学意义(P<0.05)。经多因素logistic回归分析,术后脑脊液漏、低蛋白血症是胶质瘤手术患者术后继发鲍曼不动杆菌颅内感染的独立危险因素(P<0.05)。基于胶质瘤手术患者术后继发鲍曼不动杆菌颅内感染多因素logistic回归分析构建预测模型曲线下面积(AUC)为0.807(95%可信区间为0.666~0.908,P<0.001),Youden指数为0.460,敏感度为75.00%,特异度为70.97%。结论术后脑脊液漏、低蛋白血症是胶质瘤手术患者术后继发鲍曼不动杆菌颅内感染的重要因素,针对此建立的预测模型在指导临床评估胶质瘤手术患者术后继发鲍曼不动杆菌颅内感染风险上具有一定价值。

Objective To explore the risk factors of secondary intracranial infection of Acinetobacter baumannii in patients with glioma after surgery and build a prediction modell.Methods The clinical data of 90 patients with intracranial infection after surgery for glioma were collected.According to the test results,the patients enrolled were divided into Acinetobacter baumannii infection group(n=32)and non-Acinetobacter baumannii infection group(n=58).To analyze the risk factors of intracranial infection of Acinetobacter baumannii in glioma patients after surgery,use multiple Logistic regression analysis to screen the independent risk factors and establish a prediction model,draw the working characteristics(ROC)curve of subjects to test the effectiveness of the prediction model.Results There were statistically significant differences between the 2 groups in terms of postoperative cerebrospinal fluid leakage,preoperative preventive use of antibiotics,perioperative hormone use,preoperative GCS score,and hypoproteinemia(P<0.05).Multivariate logistic regression analysis found that postoperative cerebrospinal fluid leakage,preoperative GCS score<8,and hypoproteinemia were independent risk factors for intracranial infection induced by Acinetobacter baumannii in glioma patients after surgery(P<0.05).A prediction model was constructed based on these risk factors,and the area under the curve(AUC),Youden index,sensitivity and specificity of this prediction model were 0.807(95%CI:0.666~0.908,P<0.001),0.460,75.00%,and 70.97%.Conclusion Postoperative cerebrospinal fluid leakage and hypoproteinemia are important factors influencing the occurrence of intracranial infection induced by Acinetobacter baumannii in glioma patients after surgery.The prediction model constructed based on these factors is of value in risk of assessment of intracranial infection induced by Acinetobacter baumannii in glioma patients after surgery.