危重症患者替加环素相关低纤维蛋白原血症发生风险的Nomogram预测模型构建与验证

Construction and validation of a Nomogram prediction model for tigecycline-related hypofibrinogenemia risk in critically ill patients

目的探讨替加环素致危重症患者纤维蛋白原减少的危险因素,建立Nomogram预测模型并进行验证。方法回顾性收集2019年1月1日至2023年12月31日在内蒙古自治区人民医院重症监护病房(ICU)接受替加环素治疗的重症感染患者资料,通过单因素和多因素Logistic回归分析,筛选替加环素相关低纤维蛋白原血症的危险因素。构建Nomogram图预测模型,并利用受试者工作特征(Receiver operating characteristic,ROC)曲线、校准曲线和决策曲线分析(Decision curve analysis,DCA)对模型进行验证。结果共纳入156例在ICU接受替加环素治疗的重症感染患者,其中63例发生低纤维蛋白原血症,发生率为40.4%。多因素Logistic回归分析结果显示,疗程(OR=1.36,95%CI:1.21~1.53,P<0.001)、基线纤维蛋白原水平(OR=0.58,95%CI:0.42~0.80,P<0.001)、高剂量(OR=3.55,95%CI:1.33~9.42,P=0.011)是替加环素相关低纤维蛋白原血症的危险因素。所有入组患者按7∶3的比例随机分为训练集和验证集。训练集109例,验证集47例,两组间年龄、性别比例、合并症比较,差异无统计学意义(P>0.05)。训练集和验证集ROC曲线下面积AUC分别为0.886(95%CI:0.827~0.946)和0.782(95%CI:0.639~0.925),训练集和验证集Hosmer-Lemeshow检验的P值分别为0.837、0.527。在较大的阈值范围内(0.1~0.7)创建的Nomogram图能够获得更多的净效益。结论疗程、基线纤维蛋白原水平、高剂量是替加环素相关低纤维蛋白原血症的危险因素,构建的Nomogram预测模型具有良好的预测效能,有助于临床决策。

Objective To explore the risk factors of fibrinogen reduction in critically ill patients caused by tigecycline,and establish Nomogram prediction model and validate it.Methods The data of severely infected patients treated with tigecycline in the intensive care unit(ICU)of the Inner Mongolia People's Hospital from January 1,2019 to December 31,2023 were retrospectively collected,and risk factors for tigecycline-associated hypofibrinogenemia were screened by univariate and multivariate Logistic regression analysis.A Nomogram plot prediction model was constructed,and the model was validated using receiver operating characteristic(ROC)curves,calibration curves,and decision curve analysis(DCA).Results A total of 156 patients with severe infections treated with tigecycline in the ICU were included,of which 63 developed hypofibrinogenemia,with an incidence rate of 40.4%.The results of multivariable Logistic regression analysis showed that the duration of treatment(OR=1.36,95%CI:1.21~1.53,P<0.001),baseline fibrinogen level(OR=0.58,95%CI:0.42~0.80,P<0.001),and high dose(OR=3.55,95%CI:1.33~9.42,P=0.011)were risk factors for tigecycline-associated hypofibrinogenemia.All enrolled patients were randomized into a training set and a validation set in a 7∶3 ratio.There were no significant differences in age,gender ratio and complication between the training set(n=109)and the validation set(n=47)(P>0.05).The AUC of the area under the ROC curve for the training set and validation set was 0.886(95%CI:0.827~0.946)and 0.782(95%CI:0.639~0.925),respectively,and the P-values of the Hosmer-Lemeshow test for the training set and validation set were 0.837,and 0.527,respectively.In the larger threshold range(0.1~0.7),the established Nomograms obtained more net benefit.Conclusion Duration of treatment,baseline fibrinogen level,and high dose are risk factors for tigecycline-associated hypofibrinogenemia.The constructed Nomogram prediction model demonstrates good predictive performance,which is helpful for clinical decision-making.