静脉溶栓急性缺血性脑卒中继发感染的风险因素和列线图模型构建

Risk factors for secondary infection in patients with acute ischemic stroke undergoing intravenous thrombolysis and construction of a nomogram model

目的探索静脉溶栓急性缺血性脑卒中(AIS)患者继发感染的风险因素并构建临床预测模型。方法回顾分析2016年12月—2021年12月在南京鼓楼医院行静脉溶栓的391例AIS患者临床资料,根据是否继发感染分为感染组(75例)和非感染组(316例)。结果年龄(OR=1.049,95%CI 1.017~1.082)、肾功能不全史(OR=3.76,95%CI 1.382~9.966)、降压药物史(OR=0.298,95%CI 0.144~0.562)、溶栓后出血转化(OR=2.851,95%CI1.105~7.36)、入院时WBC(OR=1.17,95%CI 1.045~1.313)、PT(OR=1.585,95%CI 1.206~2.167)以及吞咽困难(OR=8.309,95%CI 4.091~17.269)为继发感染的独立危险因素;列线图预测模型的ROC曲线下面积为0.867,截断值为0.180,具有良好的区分度和校准度。根据列线图预测概率截断值将继发感染风险分为高风险组和低风险组,低风险组累积存活率显著高于高风险组(P<0.0001)。结论年龄、肾功能不全史、降压药物史、溶栓后出血转化、入院时白细胞计数(WBC)、凝血酶原时间(PT)和吞咽困难是静脉溶栓AIS患者继发感染的影响因素,基于以上风险因素构建的列线图预测模型对继发感染和90 d生存均具有良好的预测价值。

Objective To investigate the risk factors for secondary infection in patients with acute ischemic stroke(AIS)undergoing intravenous thrombolysis,and to construct a nomogram model.Methods A retrospective analysis was performed for the clinical data of 391 patients with AIS who underwent intravenous thrombolysis in Nanjing Drum Tower Hospital retrospectively from December 2016 to December 2021,and according to the presence of absence of secondary infection,they were divided into infection group with 75 patients and non-infection group with 316 patients.Results Age[odds ratio(OR)=1.049,95%confidence interval(CI)1.017-1.082],history of renal insufficiency(OR=3.76,95%CI 1.382-9.966),history of antihypertensive drugs(OR=0.298,95%CI 0.144-0.562),hemorrhagic transformation after thrombolysis(OR=2.851,95%CI 1.05-7.36),white blood cell count(WBC)on admission(OR=1.17,95%CI 1.045-1.313),prothrombin time(PT)on admission(OR=1.585,95%CI 1.206-2.167),and dysphagia(OR=8.309,95%CI 4.091-17.269)were independent risk factors for secondary infection.The nomogram predictive model based on these risk factors had an area under the ROC curve of 0.867 and a cutoff value of 0.180,suggesting that the model had good discriminatory ability and calibration.According to the cutoff value of the nomogram,the patients were divided into high-risk and low-risk groups based on the risk of secondary infection,and the low-risk group had a significantly higher cumulative survival rate than the high-risk group(P<0.0001).Conclusion Age,history of renal insufficiency,history of antihypertensive drugs,hemorrhagic transformation after thrombolysis,WBC on admission,PT on admission,and dysphagia on admission are risk factors for secondary infection in AIS patients after intravenous thrombolysis,and the nomogram predictive model constructed based on the above risk factors has a good value in predicting secondary infection and 90-day survival.