老年肺部耐碳青霉烯肠杆菌感染风险预测模型的构建和验证

赵诗琦; 王书; 张颖; 王莎莎; 李静; 唐文娟; 李静; 张学敏; 李芳

doi:10.16766/j.cnki.issn.1674-4152.003243

老年肺部耐碳青霉烯肠杆菌感染风险预测模型的构建和验证

doi: 10.16766/j.cnki.issn.1674-4152.003243

赵诗琦¹,
王书²,
张颖^1, ,,
王莎莎²,
李静²,
唐文娟³,
李静⁴,
张学敏⁵,
李芳⁶

1.
安徽医科大学第三附属医院干部保健科，安徽合肥 230000
2.
合肥市滨湖医院干部保健科，安徽合肥 230000
3.
安庆市立医院全科医学科，安徽安庆 246000
4.
中国科学技术大学第一附属医院老年医学科，安徽合肥 230000
5.
安徽医科大学附属阜阳医院老年医学科，安徽阜阳 236000
6.
安徽医学高等专科学校临床医学院，安徽合肥 230000

基金项目:

合肥市卫生健康委2022年度重点应用医学研究项目 Hwk2022zd003

安徽省高等学校科学研究项目(自然科学类)重点项目 2022AH052334

详细信息

通讯作者:
张颖，E-mail：zhangying196501@163.com

中图分类号: R563.1
计量
- 文章访问数: 113
- HTML全文浏览量: 51
- PDF下载量: 14
- 被引次数: 0
出版历程
- 收稿日期: 2023-07-19
- 网络出版日期: 2024-01-13

Establishment and validation of model for the risk of Carbapenem-Resistant Enterobacteriaceae infection in elderly patients with pulmonary infection

1.
Cadre Ward, the Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230000, China

摘要

摘要: 目的分析及筛选影响老年肺部耐碳青霉烯肠杆菌(CRE)感染的高危因素，构建并验证风险Nomogram预测模型。方法回顾性对安徽地区共894例的老年(≥60岁)肺部感染痰培养为肠杆菌科细菌的住院患者的临床资料进行收集，抽取2个医院作为验证组(250例)，其余作为建模组(644例)，使用单因素Lasso回归和多变量logistic回归分析对建模组数据进行分析，确定CRE感染的独立危险因素。构建Nomogram预测模型, 并对模型进行多中心验证。结果气管插管≥72 h、长期卧床、抗生素使用种类≥2种、脑血管疾病、营养不良是老年肺部耐碳青霉烯肠杆菌感染的独立危险因素。基于上述5项独立危险因素，建立预测风险Nomogram模型，建模组和验证组2组AUC值分别为0.862、0.858；且Hosmer-Lemeshow检验可见建模组P=0.761，验证组P=0.339；Decision曲线分析显示，模型在较大的阈值内获益性均良好。结论构建老年肺部CRE感染风险预测模型具有一定的临床意义，能够针对可控因素进行早期个体化干预。
- 耐碳青霉烯类肠杆菌 /
- 肺部感染 /
- 危险因素 /
- 预测模型 /
- 多中心
Abstract: Objective To analyze and screen the high-risk factors for CRE infection in elderly people with pulmonary infection, and to construction and validate a risk nomogram prediction model. Methods Clinical data of a total of 894 elderly (≥60 years old) hospitalized patients with pulmonary infection cultured by Enterobacteriaceae bacteria in Anhui Province were retrospectively collected. Two hospitals were selected as verification group (250 cases), and the rest were used as training group(644 cases). Univariate Lasso regression and multivariate logistic regression analysis were used to analyze the modeling group data to identify independent risk factors for CRE infection. Construct a Nomogram prediction model and verify the model in multiple centers. Results The independent risk factors of CRE infection in the elderly were endotracheal intubation≥72 h, long-term bed rest, ≥2 types of antibiotics, cerebrovascular disease and malnutrition. Based on the above five independent risk factors, a Nomogram model for predicting risk was established, and the AUC values of the training group and verification group were 0.862 and 0.858. The Hosmer-Lemeshow test shows that the training group P=0.761 and the verification group P=0.339. Decision curve analysis shows that the model has good benefit within large thresholds. Conclusion The construction of a risk prediction model for the risk of CRE infection in the lungs of elderly people have some clinical significance, allowing early individualized intervention according to controllable factors.
- Carbapenem-Resistant Enterobacteriaceae /
- Pulmonary infection /
- Risk factors /
- Prediction model /
- Polycentric

HTML全文

图 1 Lasso回归系数路径图及10倍交叉验证曲线

Figure 1. Lasso regression coefficient path graph and 10-fold cross-validation curve

下载: 全尺寸图片幻灯片

图 2 老年肺部感染患者CRE感染风险模型

Figure 2. The Nomogram of risk model for carbapenem resistant Enterobacteriaceae infection in elderly patients with pulmonary infection

下载: 全尺寸图片幻灯片

图 3 老年肺部感染患者CRE感染风险模型的ROC曲线

注：曲线下面积越接近1说明模型预测能力越好。

Figure 3. The ROC curve of risk model for carbapenem resistant Enterobacteriaceae infection in elderly patients with pulmonary infection

下载: 全尺寸图片幻灯片

图 4 老年肺部感染患者CRE感染风险模型的Calibration曲线

注：校准曲线(图中实线)与斜率=1的对角线虚线(理想曲线)基本重合，证明模型预测能力良好。

Figure 4. The Calibration curve of risk model for carbapenem resistant Enterobacteriaceae infection in elderly patients with pulmonary infection

下载: 全尺寸图片幻灯片

图 5 老年肺部感染患者CRE感染风险模型的Decision曲线

注：水平横线表示不给予相关预测及干预时患者无法获得临床收益。

Figure 5. The Decision curve of risk model for carbapenem resistant Enterobacteriaceae infection in elderly patients with pulmonary infection

下载: 全尺寸图片幻灯片

表 1 建模组及验证组老年肺部感染患者一般临床特征比较

Table 1. Comparison of general clinical characteristics of elderly patients with pulmonary infection between the modeling group and the verification group

项目	建模组(n=644)	验证组(n=250)	统计量	P值
年龄(x±s，岁)	80.9±8.0	76.7±9.0	6.698^a	＜0.001
性别(男性/女性，例)	442/202	157/93	1.541^b	0.215
吸烟史[例(%)]	67(10.4)	50(20.0)	2.602^b	0.107
药物过敏史[例(%)]	31(4.8)	34(13.6)	1.754^b	0.185
手术史[例(%)]	356(55.3)	126(50.4)	0.157^b	0.692
既往住院史[例(%)]	512(79.5)	166(66.4)	0.779^b	0.377
长期卧床[例(%)]	263(40.8)	118(47.2)	3.455^b	0.063
合并症[例(%)]
其他部位感染	228(35.4)	80(32.0)	1.722^b	0.188
心力衰竭	136(21.1)	48(19.2)	0.021^b	0.884
休克	112(17.4)	14(5.6)	2.893^b	0.089
重症肺炎	193(29.9)	79(31.6)	1.885^b	0.170
呼吸衰竭	160(24.8)	56(22.4)	1.270^b	0.260
基础疾病[例(%)]
慢性阻塞性肺疾病	102(15.8)	49(19.6)	0.124^b	0.725
慢性肺源性心脏病	37(5.7)	15(6.0)	0.270^b	0.603
冠心病	156(24.2)	74(29.6)	0.007^b	0.935
糖尿病	171(26.6)	64(25.6)	2.806^b	0.094
高血压	376(58.4)	134(53.6)	0.029^b	0.865
消化道出血	40(6.2)	16(6.4)	0.373^b	0.541
肿瘤	179(27.8)	68(27.2)	2.064^b	0.151
动脉硬化	232(36.0)	87(34.8)	0.439^b	0.507
脑血管疾病	413(64.1)	145(58.0)	0.001^b	0.979
治疗相关因素[例(%)]
抗生素使用时长≥2周	190(29.5)	102(40.8)	2.941^b	0.086
抗生素使用种类≥2种	246(38.2)	113(45.2)	0.790^b	0.374
住院时长[M(P₂₅, P₇₅)，d]	15.66(12.00，18.00)	16.06(14.00，18.00)	-1.010^c	0.313
治疗中吸痰[例(%)]	483(75.0)	173(69.2)	0.250^b	0.617
有创操作[例(%)]
气管插管≥72 h	106(16.9)	61(24.4)	3.262^b	0.071
留置胃管	473(73.4)	159(63.6)	0.419^b	0.518
留置导尿管	331(51.4)	111(44.4)	0.674^b	0.412
老年综合征[例(%)]
痴呆	183(28.4)	46(18.4)	3.808^b	0.051
营养不良	197(30.6)	80(32.0)	3.371^b	0.066
实验室检查指标[M(P₂₅, P₇₅)]
白细胞计数(×10⁹/L)	10.3(6.7, 12.3)	12.3(6.1, 11.7)	-1.860^c	0.063
中性粒百分比(%)	77.8(69.3, 88.0)	77.0(68.1, 87.9)	-0.586^c	0.558
红细胞计数(×10⁹/L)	3.8(3.3, 4.3)	3.8(3.3, 4.3)	-0.537^c	0.591
血红蛋白(g/L)	112.2(97.0, 128.0)	114.4(99.0, 131.0)	-1.671^c	0.095
ALT(μ/L)	32.2(11.3, 31.7)	29.3(11.0, 29.3)	-0.588^c	0.556
AST(μ/L)	45.4(17.0, 38.5)	43.3(16.0, 35.0)	-1.815^c	0.069
肌酐(μmol/L)	102.2(53.1, 99.7)	93.3(51.8, 97.0)	-0.842^c	0.400
尿素(mmol/L)	10.5(5.0, 10.7)	7.7(4.6, 9.0)	-2.565^c	0.010
白蛋白(g/L)	35.1(33.0, 38.3)	34.8(31.2, 38.3)	-1.825^c	0.068
注：^a为t值，^b为χ²值，^c为Z值。其他部位感染包括血液、尿液、引流液、腹腔等；抗生素使用时长≥2周指不同抗生素总使用疗程≥2周；抗生素使用种类包括所有针对阴性菌及阳性菌的抗生素。

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表 2 CRE组和CSE组老年肺部感染患者菌株类型分布情况[例(%)]

Table 2. Distribution of bacterial strains in elderly patients with pulmonary infection between CRE group and CSE group [cases(%)]

组别	例数	肺炎克雷伯菌	阴沟肠杆菌	大肠埃希菌	其他^a
CRE组	404	262(64.9)	29(7.2)	52(12.8)	61(15.1)
CSE组	490	311(63.5)	41(8.4)	97(19.8)	41(8.3)
注：^a包括弗劳地枸橼酸杆菌、产气克雷伯菌、产酸克雷伯菌、变栖克雷伯菌、粘质沙雷菌等。

下载: 导出CSV

表 3 老年肺部感染患者CRE感染的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of CRE infection in elderly patients with pulmonary infection

项目	B	SE	Wald χ²	P值	OR值(95%CI)
气管插管≥72 h	0.701	0.336	4.353	0.037	2.015(1.043~3.891)
长期卧床	1.598	0.213	56.176	＜0.001	4.945(3.256~7.511)
抗生素使用种类≥2种	0.451	0.223	4.085	0.043	1.569(1.014~2.429)
脑血管疾病	1.282	0.231	30.656	＜0.001	3.603(2.289~5.671)
营养不良	1.558	0.252	38.144	＜0.001	4.747(2.896~7.783)

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