老年髋部骨折术后并发肺部感染的影响因素分析及列线图预测模型的构建

Influencing factors of postoperative pulmonary infections in elderly patients with hip fracture and construction of a nomogram prediction model

目的:探讨老年髋部骨折患者术后并发肺部感染的影响因素,并根据影响因素绘制列线图,预测老年髋部骨折患者术后并发肺部感染的风险。方法:选取2020年1月至2023年5月于河南大学附属郑州市骨科医院创伤骨科接受手术的老年髋部骨折患者521例,记录患者的临床资料,并用随机数字表法分为训练集(417例)和验证集(104例)。在训练集中通过单因素分析和多因素Logistic回归分析确定老年髋部骨折患者术后并发肺部感染的影响因素,建立风险预测模型的列线图,并分别在训练集和验证集中绘制受试者工作特征(ROC)曲线与校准曲线对预测模型进行评估。结果:纳入521例髋部骨折患者中,男169例,女352例。多因素Logistic回归分析结果显示,高龄[比值比(OR)=1.066,95%可信区间(CI):1.015~1.121]、红细胞分布宽度(OR=1.484,95%CI:1.190~1.849)、白蛋白(OR=0.899,95%CI:0.825~0.979)、C反应蛋白(OR=1.010,95%CI:1.003~1.016)、慢性阻塞性肺疾病(OR=4.531,95%CI:2.050~10.017)是老年髋部骨折患者术后并发肺部感染的影响因素,差异有统计学意义(P<0.05)。根据影响因素构建出列线图模型,训练集和验证集ROC曲线的曲线下面积分别为0.869(95%CI:0.833~0.900)、0.884(95%CI:0.806~0.939),校准曲线显示预测风险与实际肺部感染发生率有较好一致性。结论:高龄、红细胞分布宽度、白蛋白、C反应蛋白、慢性阻塞性肺疾病是老年髋部骨折术后并发肺部感染的影响因素,据此建立的预测模型具有可靠的预测价值。

Objective To investigate the influencing factors of postoperative pulmonary infections in elderly patients with hip fracture,and to predict the risk of postoperative pulmonary infections in elderly patients with hip fracture by constructing a nomogram based on the influencing factors.Methods A total of 521 elderly hip fracture patients who underwent surgery in the Trauma Orthopedics Department of Zhengzhou Orthopedics Hospital Affiliated to Henan University,from January 2020 to May 2023 were selected.Clinical data of the patients were recorded,and the patients were randomly divided into a training group(n=417)and a validation group(n=104)by the random number table method.In the training group,influencing factors for postoperative pulmonary infections in elderly hip fracture patients were determined through univariate analysis and multivariate Logistic regression analysis.A nomogram of the risk prediction model was constructed,and the receiver operating characteristic(ROC)curves and calibration curves were drawn in both the training and validation groups to assess the predictive model.Results Among the 521 cases of hip fracture patients included,there were 169 males and 352 females.The results of the multivariate Logistic regression analysis showed that advanced age[odds ratio(OR)=1.066,95%confidence interval(CI):1.015-1.121],red blood cell distribution width(OR=1.484,95%CI:1.190-1.849),albumin(OR=0.899,95%CI:0.825-0.979),C-reactive protein(OR=1.010,95%CI:1.003-1.016),chronic obstructive pulmonary disease(OR=4.531,95%CI:2.050-10.017)were influencing factors for postoperative pulmonary infections in elderly hip fracture patients,with statistically significant differences(P<0.05).A nomogram was constructed based on these influencing factors,and the areas under the ROC curves for the training group and validation group were 0.869(95%CI:0.833-0.900)and 0.884(95%CI:0.806-0.939),respectively.The calibration curve showed good consistency between predicted risk and the actual incidence of pulmonary infections.Conclusion Advanced age,red blood cell distribution width,albumin,C-reactive protein,and chronic obstructive pulmonary disease are influencing factors for postoperative pulmonary infections in elderly hip fracture patients.The predictive model established based on these factors has reliable predictive value.