多重耐药肺炎克雷伯菌医院感染临床特征及预后风险模型的建立

Clinical characteristics of multi-drug resistance Klebsiella pneumonia nosocomial infection and establishment of its risk prediction model

目的分析多重耐药肺炎克雷伯菌(MDR-Kpn)医院感染临床特征及死亡危险因素,并基于危险因素构建患者死亡风险的列线图模型。方法回顾性分析110例MDR-Kpn感染患者临床资料,根据28天预后情况将其分为死亡组31例和存活组79例。采用Cox比例风险模型分析患者28天死亡的危险因素,采用R语言构建基于危险因素的列线图模型,绘制受试者工作特征曲线(ROC)分析列线图模型的预测效果。结果MDR-Kpn医院感染患者主要来源于重症监护室(44.5%),主要感染类型为呼吸道感染(63.6%)。多因素Cox比例风险模型结果显示,年龄、气管切开、机械通气、气管插管、导尿管是MDR-Kpn医院感染28天死亡的独立危险因素(均P<0.05)。ROC曲线显示,基于危险因素构建的列线图模型预测MDR-Kpn医院感染28天死亡的曲线下面积(AUC)为0.847(95%CI:0.766~0.909),特异度为81.0%,敏感度为74.2%。结论年龄、气管切开、机械通气、气管插管、导尿管是MDR-Kpn医院感染28天死亡的独立危险因素,基于危险因素构建的列线图模型具有良好的预测效果,能为医护人员采取针对性的防治策略提供参考。

Objective To analyze the clinical characteristics and prognostic factors of Klebsiella pneumonia(MDR-Kpn)nosocomial infection,and to establish a nomograph based on risk factors.Methods The clinical data of 110 MDR-Kpn nosocomial infection patients was retrospective analyzed,and they were divided into the death group(31 cases)and the survival group(79 cases).Cox proportional hazards model was implemented to analyze the influencing factors for risk of death,R language was employed to establish a nomogram model to predict the mortality risk of MDR-Kpn nosocomial infection,and the ROC curve was drawn to assess the performance of the nomogram model for predicting the mortality of patients with MDR-Kpn nosocomial infection.Results The majority of the patients with MDR-Kpn nosocomial infection were treated in the Intensive Care Unit(ICU)(44.5%),and the majority of the patients(63.6%)had respiratory tract infection.The results from multi Cox proportional hazards model showed that age,tracheostomy,mechanical ventilation,tracheal intubation,and catheterization were independent risk factors for predicting mortality of patients with MDR-Kpn nosocomial infection(all P<0.05).The results from ROC curve demonstrated that the AUC of nomograph based on risk factors for predicting 28-day mortality from MDR-Kpn nosocomial infection were 0.847(95%CI:0.766~0.909),with a specificity of 81.0%and a sensitivity of 74.2%.Conclusion Age,tracheostomy,mechanical ventilation,tracheal intubation,and catheterization are independent risk factors for predicting 28-day mortality of patients with MDR-Kpn nosocomial infection,the nomogram model based on the risk factors has well predictive performance,which is useful for clinicians to carry out targeted interventions.