透析导管相关血流感染的危险因素及风险预测模型  

Risk factors of hemodialysis catheter-related bloodstream infection and prediction model

作　　者：刘亚敏 赵培翔 王宇飞[1] 梁献慧[1,2] 王沛 刘章锁[1,2] Liu Yamin;Zhao Peixiang;Wang Yufei;Liang Xianhui;Wang Pei;Liu Zhangsuo(Blood Purification Center,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Research Institute of Nephrology,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院血液净化中心,郑州450052 [2]郑州大学肾脏病研究所,郑州450052

出　　处：《中华肾脏病杂志》2022年第1期23-28,共6页Chinese Journal of Nephrology

基　　金：综合性、数字化重大疾病新药临床评价技术示范平台建设(2020ZX09201-009);河南省高等学校重点科研项目(18B310027)。

摘　　要：目的探讨留置带隧道和涤纶套的透析导管(tunnel-cuffed catheter,TCC)的血液透析(hemodialysis,HD)患者发生导管相关血流感染(catheter-related bloodstream infection,CRBSI)的危险因素,构建感染风险预测模型。方法本研究为回顾性研究,选择2020年7月至2020年12月于郑州大学第一附属医院血透通路中心移除TCC的HD患者为研究对象,按照7∶3的比例随机分为训练集(用于模型建立)和验证集(用于模型验证)。参照2019年肾脏病预后质量倡议血管通路临床实践指南CRBSI诊断标准,将训练集分为CRBSI组与非CRBSI组,分析CRBSI发生的危险因素。应用多因素Logistic回归分析中变量的比值比(OR)值构建风险预测模型,在验证集中验证该模型的评估能力。结果共纳入254例HD患者。训练集179例,男女比例为1.36∶1,年龄(55.81±15.95)岁,中位透析龄18(8,27)个月,中位TCC留置时间15(5,24)个月,确诊CRBSI的HD患者有40例。多因素Logistic回归分析结果显示,合并糖尿病(OR=2.711,95%CI 1.174~6.258,P=0.019)、3个月内导管相关感染史(OR=3.674,95%CI 1.541~8.760,P=0.003)、1个月内护理干预≥4次(OR=3.128,95%CI 1.343~7.283,P=0.008)和中心静脉病变(OR=2.572,95%CI 1.130~5.854,P=0.024)是HD患者发生CRBSI的独立影响因素。应用多因素Logistic回归中变量的OR值取整转化为风险模型的赋分值,在训练集中将各个因素对应的分值相加得到风险评分,绘制受试者工作特征曲线(ROC曲线),ROC曲线下面积(AUC)为0.761(0.683~0.839),最大约登指数为0.461,此时对应的截断值为6分,敏感度为90.0%,特异度为56.1%;在验证集中验证该模型,AUC为0.794(0.674~0.914),截断值为6分时,敏感度为61.6%,特异度为82.5%。结论合并糖尿病、3个月内导管相关感染史、1个月内护理干预≥4次和中心静脉病变是CRBSI发生的独立危险因素,基于以上因素建立的风险预测模型对CRBSI预测具有良好的效能,可为HD患者发生CRBSI的防治提供指�Objective To investigate the risk factors for catheter-related bloodstream infection(CRBSI)in hemodialysis(HD)patients with tunnel-cuffed catheter(TCC)and construct a risk prediction model for the prevention and treatment of catheter infection.Methods It was a retrospective study.Patients who had their TCC removed in Hemodialysis Access Center of the First Affiliated Hospital of Zhengzhou University from July to December 2020 were randomly divided into a training set(for model building)and a validation set(for model validation)in the ratio of 7∶3.The training set was divided into CRBSI group and non-CRBSI group with reference to the 2019 Kidney Disease Outcomes Quality Initiative clinical practice guidelines for vascular access,and the risk factors for the occurrence of CRBSI were analyzed.The odds ratio(OR)values of the variables in the multivariate logistic regression analysis were applied to construct a risk prediction model,and the assessment ability of the model was validated in the validation set.Results A total of 254 HD patients were included.The training set consisted of 179 patients with male-to-female ratio of 1.36∶1,age of(55.81±15.95)years old,median dialysis age of 18(8,27)months,median TCC retention time of 15(5,24)months,and 40 patients with confirmed CRBSI.Logistic regression analysis showed that,combined diabetes(OR=2.711,95%CI 1.174-6.258,P=0.019),history of catheter-related infection within 3 months(OR=3.674,95%CI 1.541-8.760,P=0.003),more than 4 times nursing interventions within 1 month(OR=3.128,95%CI 1.343-7.283,P=0.008),and central venous disease(OR=2.572,95%CI 1.130-5.854,P=0.024)were the independent influencing factors for CRBSI occurrence in HD patients with TCC.The OR values of the variables in the multivariate logistic regression were rounded to the assigned scores of the risk prediction model.The corresponding scores of each factor were summed in the training set to obtain the risk score.The receiver operating characteristic(ROC)curve was plotted,with area under the curve(AUC)of

关 键 词：肾透析 导管相关性感染 危险因素 带隧道和涤纶套的透析导管 预测模型 

分 类 号：R692.5[医药卫生—泌尿科学]