ICU大便失禁患者失禁性皮炎的影响因素及预测模型构建

Influencing factors and prediction model construction of incontinence-associated dermatitis in ICU patients with fecal incontinence

目的通过分析重症监护病房(ICU)大便失禁患者发生失禁性皮炎(IAD)的影响因素,建立ICU患者大便失禁性皮炎的列线图风险预测模型。方法以南京市某三级甲等医院综合ICU 2021年8月—2022年8月收治的159例大便失禁患者为调查对象,将其中71例IAD患者作为病例组,88例非IAD患者作为对照组,通过单因素及二分类Logistic回归分析筛选大便失禁患者发生IAD的影响因素,并据此构建预测大便失禁患者发生IAD的列线图模型。分别使用校准曲线、霍斯默(H-L)偏差度检验和受试者工作特征曲线(ROC曲线)评估预测模型的准确度和区分度。结果本次研究中ICU大便失禁患者的IAD发生率为44.65%。单因素分析显示,PAT评分、大便失禁频率、水样便、使用止泻药物、约束是ICU大便失禁患者发生IAD的影响因素(P<0.05)。二分类Logistic回归分析显示,PAT评分、是否水样便、是否使用止泻药物为ICU大便失禁患者发生IAD的影响因素(P<0.05),其中高PAT评分、水样便和未使用止泻药物的ICU大便失禁患者发生IAD的风险越高。考虑统计学意义及临床意义,基于PAT评分、大便失禁频率、水样便及使用止泻药物构建列线图模型,列线图模型验证结果显示,校准曲线为斜率接近1的直线、H-L偏差度检验(χ^(2)=1.826,P=0.986)、AUC=0.993均显示该模型具有良好的准确度和区分度。结论ICU大便失禁患者IAD的发生率较高,本研究基于4项影响因素构建ICU大便失禁患者IAD的风险预测模型具有良好的准确度和区分度,有利于医护人员尽早筛查高风险患者和采取个性化的干预策略,从而降低大便失禁性皮炎的发生率。

Objective To analyze the influencing factors of incontinence-associated dermatitis(IAD)in intensive care unit(ICU)patients with fecal incontinence,and thereby construct a nomogram risk prediction model for IAD patients in ICU.Methods A total of 159 patients with fecal incontinence admitted to the comprehensive ICU of a tertiary Grade A hospital in Nanjing from August 2021 to August 2022 were included in this study.Among them,71 cases with IAD were selected as the case group,while 88 cases without IAD selected as the control group.Univariate and binary Logistic regression analyses were conducted to screen factors influencing the occurrence of IAD in patients with fecal incontinence.Based on these findings,a nomogram model was constructed to predict the occurrence of IAD in patients with fecal incontinence.The accuracy and discrimination of the prediction model were evaluated using calibration curves,the Hosmer-Lemeshow(H-L)goodness-of-fit test,and receiver operating characteristic(ROC)curves.Results The incidence of IAD among ICU patients with fecal incontinence was 44.65%in this study.Univariate analysis showed that the PAT scores,frequency of fecal incontinence,watery stools,use of anti-diarrheal medications,and restraint were factors influencing the occurrence of IAD in ICU patients with fecal incontinence(P<0.05).Binary Logistic regression analysis showed that PAT scores,whether the stool were watery and whether antidiarrheal medications were used were factors influencing the occurrence of IAD in ICU patients with fecal incontinence(P<0.05).Specifically,ICU patients with fecal incontinence who had high PAT scores,watery stool,and did not use antidiarrheal medications were at higher risk of developing IAD.Given statistical and clinical significance,a nomogram model was constructed based on PAT score,the fecal incontinence frequency,watery stools,and use of antidiarrheal medications.The validation results of the nomogram model showed a calibration curve that was a straight line with a slope close to 1,a H-L deviation test(χ^(2)=1.826,P=0.986),and AUC=0.993,demonstrating excellent accuracy and discrimination of the model.Conclusion The incidence of IAD is high among ICU patients with fecal incontinence.The risk prediction model of IAD in ICU patients with fecal incontinence constructed in this study based on 4 influencing factors has good accuracy and discrimination,which is beneficial for medical staffto screen high-risk patients as early as possible and implement personalized intervention strategies,thereby reducing the incidence of fecal incontinence-associated dermatitis.