输尿管结石病人术后发生尿源性脓毒症的风险预测模型构建及验证

Construction and validation of a risk prediction model for postoperative urogenic sepsis in patients with ureteral calculi

目的:基于列线图模型构建输尿管结石病人术后发生尿源性脓毒症(US)的风险预测模型,并进行验证。方法:选取2017年10月—2020年10月于我院收治的600例输尿管结石病人作为模型组,2020年11月—2022年7月于我院收治的110例输尿管结石病人作为验证组。采用Logistic回归分析探究其术后发生US的危险因素,然后构建输尿管结石病人术后发生US的列线图风险预警模型,并验证其预测效能。结果:600例输尿管结石病人中,50例发生US,发生率为8.33%。Logistic回归分析结果显示,性别、糖尿病史、手术时间、术中灌注液体量、结石大小、术前中段尿培养阳性是输尿管结石病人术后发生US的危险因素(P<0.05)。模型组与验证组的受试者工作特征曲线下面积(AUC)分别为0.910[95%CI(0.847,0.973)]和0.885[95%CI(0.797,0.973)],两组校正曲线均与标准曲线拟合较好。结论:性别、糖尿病史、手术时间、术中灌注液体量、结石大小、术前中段尿培养阳性是输尿管结石病人术后发生US的影响因素,本研究基于上述因素构建的输尿管结石病人术后发生US的列线图风险预警模型具有较高的临床应用价值。

Objective:To construct a risk prediction model for postoperative urogenital sepsis(US)in patients with ureteral calculi based on the column-line diagram model,and to validate it.Methods:600 ureteral calculi patients admitted to our hospital from October 2017 to October 2020 were selected as the model group,and 110 ureteral calculi patients admitted to our hospital from November 2020 to July 2022 were selected as the validation group.Logistic regression analysis was used to investigate the risk factors for postoperative US,and then a line drawing risk warning model for postoperative US in ureteral calculi patients was constructed and verified for its predictive efficacy.Results:Among 600 ureteral calculi patients,50 cases had US,with an incidence rate of 8.33%.Logistic regression analysis showed that gender,history of diabetes,duration of surgery,amount of intraoperative fluid instillation,calculi size,and positive preoperative mid-stage urine culture were the risk factors for postoperative US in ureteral calculi patients(P<0.05).The area under the curve(AUC)of the receiver operating characteristic of the model and validation groups were 0.910(95%CI 0.847-0.973)and 0.885(95%CI 0.797-0.973).Both sets of calibration curves were well fitted to the standard curve.Conclusion:Sex,history of diabetes,operation time,intraoperative fluid volume,calculi size,and positive preoperative mid-stage urine culture are the factors influencing the occurrence of postoperative US in patients with ureteral calculi.The columnar risk warning model of postoperative US in patients with ureteral calculi constructed based on the above mentioned factors in the present study has a high clinical application value.