早期预测鲍曼不动杆菌性呼吸机相关肺炎列线图的建立及应用  

Establishment and application of nomogram for early prediction of Acinetobacter baumannii ventilatorassociated pneumonia

作　　者：李宾 刘振宁[1] 姜艳[1] LI Bin;LIU Zhen-ning;JIANG Yan(Comprehensive Emergency,Shengjing Hospital Affiliated to China Medical University,Shenyang,Liaoning 110000,China)

机构地区：[1]中国医科大学附属盛京医院综合急诊,辽宁沈阳110000

出　　处：《中国病原生物学杂志》2022年第6期710-713,717,共5页Journal of Pathogen Biology

摘　　要：目的 探讨影响鲍曼不动杆菌性呼吸机相关肺炎(VAP)的危险因素,构建预测鲍曼不动杆菌性VAP的列线图模型,并评估模型的区分度和一致性。方法 2017年9月-2021年9月中国医科大学附属盛京医院重症监护病房行机械通气治疗的鲍曼不动杆菌性VAP患者70例(研究组),行机械通气治疗的非鲍曼不动杆菌性VAP患者122例(对照组)。收集患者临床资料,采用单因素及多因素Logistic回归分析筛选影响鲍曼不动杆菌性VAP的危险因素;采用R软件构建预测鲍曼不动杆菌性VAP的列线图模型,并使用ROC曲线及校准曲线验证列线图模型的区分度和一致性。结果 研究组与对照组比较患者机械通气时间,APACHEⅡ评分,使用机械通气方式、使用糖皮质激素、使用≥3种抗菌药物以及留置胃管者的比例差异均有统计学意义(P均<0.05。多因素Logistic回归分析显示,机械通气方式(气管切开)(OR=4.079,95%CI=2.019~8.241)、使用糖皮质激素(OR=2.099,95%CI=1.009~4.364)、使用≥3种抗菌药物(OR=2.311,95%CI=1.139~4.689)、留置胃管(OR=3.051,95%CI=1.516~6.139)是影响鲍曼不动杆菌性VAP的危险因素(均P<0.05。构建的列线图预测模型具有较好的区分度(ROC曲线下面积为0.806,95%CI=0.745~0.867)和一致性(Hosmer-Lemeshow拟合优度检验χ^(2)=6.835,P=0.554)。结论 构建的预测鲍曼不动杆菌性VAP发生风险的列线图模型具有较好的区分度和一致性。Objective To explore the risk factors that affect Acinetobacter baumannii ventilator-associated pneumonia(VAP),construct a nomogram model for predicting A.baumannii VAP,and evaluate the discrimination and consistency of the model.Methods From September 2017 to September 2021,70 patients with A.baumannii VAP(study group) and 122 patients with non-A.baumannii VAP(control group) who were treated by mechanical ventilation in the intensive care unit of Shengjing Hospital Affiliated to China Medical University were included.The patient clinical data were collected,Single-factor and multi-factor Logistic regression analyses was used to screen the risk factors that affected A.baumannii VAP;R software was used to construct a nomogram model to predict the VAP of A.baumannii,and ROC curve and calibration curve were used to verify the discrimination and consistency of the nomogram model.Results Compared with the study group and the control group,there were statistically significant differences in mechanical ventilation methods,mechanical ventilation time,APACHE Ⅱ score,using of glucocorticoids,using of ≥3 kinds of antibacterial drugs,and proportion of indwelling stomach tubes(P<0.05).The results of multivariate Logistic regression analysis showed that mechanical ventilation(tracheostomy)(OR=4.079,95%CI=2.019-8.241),using of glucocorticoids(OR=2.099,95%CI=1.009-4.364),using of ≥3 kinds of antibacterial drugs(OR=2.311,95%CI=1.139-4.689),and indwelling gastric tube(OR=3.051,95%CI=1.516-6.139) were risk factors affecting A.baumannii VAP(P<0.05).The constructed nomogram prediction model had a good degree of discrimination(the area under the ROC curve was 0.806(95%CI=0.745-0.867)) and consistent(Hosmer-Lemeshow goodness of fit test χ~2=6.835,P=0.554).Conclusion The nomogram model constructed in this study to predict the risk of A.baumannii VAP has good discrimination and consistency.

关 键 词：鲍曼不动杆菌 呼吸机相关性肺炎 机械通气 列线图模型 

分 类 号：R378[医药卫生—病原生物学]