维持性血液透析患者导管相关性感染影响因素及其列线图预测模型构建

Influencing factors of catheter associated infection in maintenance hemodialysis patients and the construction of nomogram prediction model

目的分析维持性血液透析(MHD)患者导管相关性感染影响因素及其列线图预测模型构建。方法选取2020年10月-2023年10月于武汉市第一医院血液净化中心行维持性血液透析患者240例作为研究对象,根据导管感染情况分为感染组(n=56)和未感染组(n=184),归纳MHD患者发生导管感染的危险因素,并构建预测模型,绘制风险列线图,并应用受试者工作(ROC)曲线分析预测模型的诊断效能。结果感染组患者的年龄、抗菌药物使用种类、侵入性操作、中心静脉置管及血清白蛋白、尿素氮、血肌酐和白细胞计数水平均与未感染组差异有统计学意义(P均<0.05)。Logstic回归分析结果显示,年龄,中心静脉置管、置管时间、抗菌药物使用种类及侵人性操作是MHD患者发生导管感染的影响因素,而血清白蛋白是保护因素(P<0.05);ROC曲线分析结果显示,预测模型的曲线下面积(AUC)为0.942(0.894~0.990),灵敏度为93.75%,特异度为85.61%,约登指数为0.788。结论高龄、中心静脉置管、置管时间过长、入侵性操作及血清白蛋白水平偏低等因素均与MHD患者发生导管感染存在密切联系;本研究根据上述风险因素所构建的风险预测模型具有较高的诊断效能。

OBJECTIVE To analyze the factors affecting catheter infection in maintenance haemodialysis(MHD)patients and construct a predictive model of nomogram.METHODS Totally 24O patients undergoing maintenance haemodialysis at the Hemodialysis Center of Wuhan First Hospital between Oct.2020 and Oct.2023 were selected as study subjects,and were divided into the infected group(n=56)and the uninfected group(n=184)according to whether they had catheter infections or not.The risk factors for the occurrence of catheter infections in MHD patients were summarized,and a prediction model was constructed to plot the nomogram,and the diagnostic efficacy of the prediction model was analyzed by the receiver operating characteristics(ROC)curve.RESULTS The age,antibiotic use,invasive operation,central venous catheterization,serum albumin,urea nitrogen,serum creatinine and white blood cell count in the infected group were significantly different from those of the uninfected group(all P<0.05).The results of the logistic regression analysis showed that age,central venous catheter placement,duration of catheter placement,type of antibiotic use,and presence of invasive operation were the independent risk factors for the occurrence of catheter infection in MHD patients,while serum albumin was a protective factor(all P<0.05).The results of ROC curve analysis showed that the AUC of the prediction model was 0.942(0.8940.990),the sensitivity was 93.75%,the specificity was 85.61%,and the index of the Yoden was 0.788.CONCLUSION Advanced age,prolonged central venous catheterization,invasive operation and low serum albumin levels were all closely related to catheter infection in MHD patients.The risk prediction model constructed based on the above risk factors in this study had high diagnostic efficiency.