胫骨平台骨折术后肺部感染危险因素分析及列线图模型的构建

Analysis on the risk factors and construction of a nomogram model for postoperative pulmonary infection after tibial plateau fractures surgery

目的探讨胫骨平台骨折患者术后肺部感染的危险因素并构建列线图模型,以评估术后并发肺部感染的风险。方法回顾性分析2021年4月至2023年7月南京市高淳人民医院和南京市高淳中医院收治的322例胫骨平台骨折手术患者的临床资料。根据肺部感染诊断标准,28例患者发生肺部感染(感染组),294例患者未发生肺部感染(无感染组)。采用单因素分析筛选出与胫骨平台骨折术后肺部感染相关的因素,并采用多因素logistic回归分析引起胫骨平台骨折术后肺部感染的危险因素。将独立危险因素构建列线图模型,采用ROC曲线、校准曲线检验模型的预测效能。结果两组患者年龄、高龄比例、骨折类型、吸烟史、饮酒史、骨折至入院时间、合并心血管疾病、呼吸系统疾病、神经系统疾病比例、WBC等比较差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示高龄、有吸烟史、有饮酒史、骨折至入院时间越长、WBC异常、超敏C反应蛋白(hs-CRP)异常均是胫骨平台骨折术后肺部感染的独立危险因素(均P<0.05)。将高龄、吸烟史、饮酒史、骨折至入院时间、WBC、hs-CRP等独立危险因素结合起来,构建胫骨平台骨折术后肺部感染的列线图模型,ROC曲线对模型进行验证,结果发现该模型的AUC为0.947,说明该模型具有良好的预测效能;校准曲线发现该模型预测曲线与临床实际结果贴合度良好。结论高龄、有吸烟史、有饮酒史、骨折至入院时间越长、WBC异常、hs-CRP异常等是胫骨平台骨折术后肺部感染的危险因素,基于这些因素构建的列线图可较好识别高风险患者。

Objective To explore the risk factors and construct a nomogram model for postoperative pulmonary infection in patients with tibial plateau fractures.Methods The clinical data of 322 patients with tibial plateau fractures who underwent surgery in Nanjing Gaochun People's Hospital and Nanjing Gaochun Hospital of Traditional Chinese Medicine from April 2021 to July 2023 were retrospectively analyzed.According to the diagnostic criteria of pulmonary infection,28 patients developed pulmonary infection(infection group),and 294 patients did not(non-infection group).Univariate analysis was used to screen the factors related to pulmonary infection after tibial plateau fractures surgery,and multivariate logistic regression analysis was used to analyze the risk factors affecting pulmonary infection after tibial plateau fractures surgery.A nomogram model was constructed for the independent risk factors,and the predictive efficacy of the model was tested using ROC curves and calibration curves.Results There were statistically significant differences in age,proportion of advanced age,fracture type,history of smoking,history of alcohol consumption,fracture-to-admission time,proportion of cardiovascular diseases,proportion of respiratory diseases,proportion of neurological diseases,and WBC between the two groups(all P<0.05).Multifactorial logistic regression analysis showed that advanced age,history of smoking,history of alcohol consumption,longer fracture-to-admission time,abnormal WBC,and abnormal hs-CRP were all independent risk factors for pulmonary infections after tibial plateau fractures surgery(all P<0.05).Independent risk factors such as advanced age,history of smoking,history of alcohol consumption,fracture-to-admission time,WBC,hs-CRP were combined to construct a nomogram model of pulmonary infection after tibial plateau fractures surgery,and the ROC curve was used to validate the model,which was found to have an AUC of 0.947,indicating that the model had a good predictive efficacy.Calibration curves were showed that the prediction curves of this model had a good fit with the clinical actual results.Conclusion Advanced age,history of smoking,history of alcohol consumption,longer fracture-to-admission time,abnormal WBC,and abnormal hs-CRP are risk factors for pulmonary infection after tibial plateau fractures surgery.The nomogram constructed based on these factors can well identify high-risk patients.