尿毒症高通量血液透析患者导管相关血流感染危险因素分析

Risk factors analysis of catheter-related bloodstream infection in uraemic patients with high throughput blood

目的分析尿毒症高通量血液透析患者发生导管相关性血流感染(CRBSI)的危险因素及其预测模型的构建。方法收集2022年10月至2023年10月于本院接受高通量血液透析治疗的120例尿毒症患者临床资料,进行回顾性分析。通过Logistic回归分析影响尿毒症高通量血液透析患者发生CRBSI的独立危险因素,绘制受试者工作特征(ROC)曲线评估模型预测效果。结果120例患者中发生CRBSI者34例,未发生CRBSI者86例,CRBSI发生率28.33%。CRBSI组年龄、吸烟史、导管留置时间≥15d、置管次数≥2次、透析时间≥12个月、营养状况不良、合并低蛋白血症、治疗依从性差、1月内使用过抗菌药物者占比及尿素氮水平较无CRBSI组高(P<0.05)。年龄、吸烟史、导管留置时间、1月内使用过抗菌药物和尿素氮水平是影响尿毒症高通量血液透析患者发生CRBSI的独立危险因素(P<0.05)。AUC为0.954,灵敏度为58.30%,特异度为82.00%,95%CI为(0.925~0.983),说明模型具有较好的预测价值(P<0.05)。结论年龄、吸烟史、导管留置时间、1月内使用过抗菌药物和尿素氮水平是影响尿毒症高通量血液透析患者发生CRBSI的独立危险因素,以此为基础构建预测模型,可有效筛查CRBSI高风险患者。

Objective To analyze the risk factors of catheter-related bloodstream infection(CRBSI)in uremic patients undergoing Qualcomm hemodialysis and to build a prediction model.Methods The clinical data of 120 uremia patients who received Qualcomm hemodialysis in our hospital from October 2022 to October 2023 were collected and analyzed retrospectively.Logistic regression was used to analyze the independent risk factors of CRBSI in uremic Qualcomm hemodialysis patients,and the ROC curve was drawn to evaluate the prediction effect of the model.Results Among 120 patients,34 cases developed CRBSI,86 cases did not,and the incidence of CRBSI was 28.33%.The age,smoking history,indwelling time of catheter≥15d,times of indwelling catheter≥2 times,dialysis time≥12 months,poor nutritional status,hypoproteinemia,poor treatment compliance,the proportion of people who used antibiotics within one month and the level of urea nitrogen in CRBSI group were higher than those in non-CRBSI group(P<0.05).Age,smoking history,catheter indwelling time,use of antibiotics within one month and urea nitrogen level are independent risk factors for CRBSI in uremia patients undergoing Qualcomm hemodialysis(P<0.05).AUC is 0.954,sensitivity is 58.30%,specificity is 82.00%,and 95%CI is(0.925~0.983),which shows that the model has good prediction value(P<0.05).Conclusions Age,smoking history,catheter indwelling time,use of antibiotics within one month and urea nitrogen level are independent risk factors for CRBSI in uremia patients undergoing Qualcomm hemodialysis.Based on these,a prediction model can be constructed to effectively screen patients with high risk of CRBSI.