动脉瘤性蛛网膜下腔出血患者围手术期内并发医院感染风险列线图模型的构建与验证  

Construction and validation of a nomogram model of nosocomial infection risk in patients with aneurysmal subarachnoid hemorrhage during perioperative period

作　　者：曾湖 徐立新[1] 陈华[1] 曹武阳 刘梦姣 阙思伟[1] Zeng Hu;Xu Lixin;Chen Hua;Cao Wuyang;Liu Mengjiao;Que Siwei(Department of Neurosurgery,the First People′s Hospital of Changde City,Changde,Hu′nan 419500,China)

机构地区：[1]湖南省常德市第一人民医院神经外科,419500

出　　处：《中国脑血管病杂志》2021年第10期679-688,723,共11页Chinese Journal of Cerebrovascular Diseases

基　　金：常德市科学技术局技术研究与开发资金项目(2018S022)。

摘　　要：目的调查动脉瘤性蛛网膜下腔出血(aSAH)患者围手术期内并发医院感染的相关因素,构建能够准确预测医院感染发生风险的列线图模型。方法采用回顾性分析的方法收集2019年1月至2021年6月在湖南省常德市第一人民医院神经外科接受手术治疗的aSAH患者的临床资料,按照3∶1的比例随机分为试验队列与检验队列。将试验队列按患者是否感染分为感染组与未感染组,并用于进行单因素分析、多因素Logistics回归分析以及列线图的构建(列线图的构建采用RStudio软件的rms程序包进行)。构建的列线图分别在试验队列与检验队列进行验证,其中采用受试者工作特征曲线(ROC)分析验证模型区分度[曲线下面积(AUC)为0.5~0.7时有较低准确性,AUC为>0.7~0.9时有一定准确性,AUC为0.9以上时有较高准确性];校准曲线(采用Brier值评估模型准确性,范围为0~1分,0~<0.25分表示模型具有预测价值,Brier得分越接近0表示模型准确度越高;采用平均绝对误差评估模型实际预测与校正后预测的一致性,平均绝对误差越接近0表示一致性越好)与Hosmer-Lemeshow检验(P>0.05表明拟合方程与真实方程基本无偏差,P值越大越好)判断模型校准度;决策曲线分析验证模型的临床有效性(决策曲线中模型的获益率高于所有患者发生医院感染并接受治疗或所有患者不发生医院感染并均不治疗,表明模型有实用性或有效)。结果共纳入aSAH患者372例,其中试验队列279例,检验队列93例;发生医院感染114例(30.65%),其中呼吸道感染59例(51.75%),泌尿系统感染18例(15.79%),中枢神经系统感染13例(11.40%,其中颅内感染9例,脑膜炎2例,无脑膜炎性椎管内脓肿2例),其他感染24例(分别为血液系统感染10例,气管炎或支气管炎8例,心血管系统感染6例)。279例试验队列患者中,未发生感染195例,发生感染84例,其中呼吸道感染49例,泌尿系感染16例,中枢神经系统感染11例Objective To investigate the related factors of nosocomial infection in patients with aneurysmal subarachnoid hemorrhage(aSAH)during the perioperative period and construct a nomogram model that can accurately predict the risk of nosocomial infection.Methods The clinical data of aSAH patients who underwent surgery in the Department of Neurosurgery,the First People′s Hospital of Changde City from January 2019 to June 2021 were retrospectively collected and analyzed.Patients were randomly divided into experimental cohort and test cohort according to a ratio of 3∶1.The experimental cohort was divided into infected group and non-infected group according to whether the patients were infected,and was used for further univariate analysis,multivariate Logistic regression analysis and the construction of nomogram(the nomogram was constructed using the RMS package of RStudio software).The constructed nomogram was verified in the experimental cohort and the test cohort respectively,and receiver operating characteristic curve(ROC)analysis was used to verify the discrimination of the model(low accuracy with area under the curve[AUC]0.5-0.7;certain accuracy with AUC>0.7-0.9;high accuracy with AUC above 0.9).Calibration curve(the Brier value is used to evaluate the accuracy of the model,ranging from 0 to 1 point.0-<0.25 points indicate that the model has predictive value,and the closer the Brier score is to 0,the higher the accuracy of the model;The average absolute error is used to evaluate the consistency between the actual prediction of the model and the corrected prediction;The closer the average absolute error is to 0,the better the consistency)and Hosmer-Lemeshow test(P>0.05 indicates that there is basically no deviation between the fitted equation and the real equation;the larger the P value,the better)were used to judge the degree of model calibration.The decision curve verifies the clinical validity of the model(When the benefit rate of the model in the decision curve is higher than that of all patients with nosocom

关 键 词：脑动脉瘤 蛛网膜下腔出血 医院感染 列线图 

分 类 号：R651.12[医药卫生—外科学]