颅脑损伤留置尿管患者导尿管相关尿路感染的风险预测列线图模型构建与验证  

Construction and validation of a nomogram model for risk prediction of catheter- associated urinary tract infection in traumatic brain injury patients with indwelling catheter

作　　者：廖利萍[1] 陈鹏 王科[1] 吴晓苏 陈英[1] 高英[2] 方清永 LIAO Li-ping;CHEN Peng;WANG Ke;WU Xiao-su;CHEN Ying;GAO Ying;FANG Qing-yong(Chongqing Emergency Medical Center,Chongqing 400014,China)

机构地区：[1]重庆市急救医疗中心神经外科,重庆400014 [2]重庆市急救医疗中心护理部,重庆400014 [3]重庆市急救医疗中心院感科,重庆400014

出　　处：《中华医院感染学杂志》2022年第12期1798-1802,共5页Chinese Journal of Nosocomiology

基　　金：重庆市科卫联合医学科研基金资助项目(2020FYYX214)。

摘　　要：目的 探究颅脑损伤留置尿管患者发生导尿管相关尿路感染(CAUTI)的危险因素,建立颅脑损伤留置尿管患者CAUTI的风险预测列线图模型,为导尿管相关尿路感染的早期预防及控制提供参考依据。方法 选取2019年1月-2021年12月重庆市急救医疗中心神经外科收治的颅脑损伤留置尿管患者为研究对象,随机抽取70%为建模组,30%为验证组,根据是否发生导尿管相关尿路感染,又分为CAUTI感染组和CAUTI非感染组。采用单因素及多因素Logistic回归分析筛选建模组颅脑损伤留置尿管患者发生CAUTI危险因素构建列线图,并在验证组中对模型进行验证。结果 共纳入815例颅脑损伤留置尿管患者,发生CAUTI 121例,CAUTI发生率为14.85%。年龄≥60岁、应激性高血糖、格拉斯哥昏迷评分(GCS)≤8分、ICU住院时间≥14 d、留置尿管时间≥30 d是颅脑损伤留置尿管患者发生CAUTI独立危险因素(P<0.05)。依此构建列线图模型并在建模组与验证组中进行验证。建模组和验证组受试者工作特征曲线(ROC)下面积分别为0.944(95%CI:0.922~0.965)和0.930(95%CI:0.898~0.963),模型区分度良好。建模组及验证组Hosmer-Lemeshow拟合优度检验结果提示模型校准度较高(P=0.708、0.831)。结论 基于Logistic回归分析构建的CAUTI风险预测列线图模型有助于筛选颅脑损伤留置尿管CAUTI高危患者,从而进行早期识别干预,改善临床预后。OBJECTIVE To explore the risk factors of catheter-associated urinary tract infection(CAUTI), and to establish a nomogram model for the risk prediction of CAUTI in patients with indwelling catheter after traumatic brain injury, so as to provide reference for early clinical prevention and control of CAUTI. METHODS Patients with indwelling urinary catheter after traumatic brain injury treated in neurosurgery of Chongqing emergency medical center from Jan. 2019 to Dec. 2021 were selected as the research subjects, and 70% of the subjects were randomly selected as the derivation group and 30% as the verification group. According to whether the patients in the two groups had CAUTI or not, they were divided into CAUTI group and non-CAUTI group. Univariate and multivariate logistic regression analysis was used to screen out the risk factors for CAUTI in patients with indwelling catheter after traumatic brain injury in the derivation group to construct a nomogram, and the model was verified in the validation group. RESULTS A total of 815 patients with craniocerebral injury with indwelling urinary catheter were included, 121 cases occurred CAUTI, with an incidence rate of 14.85%. The multivariate analysis results of the derivation group showed that age ≥60 years, stress hyperglycemia, Glasgow Coma Scale(GCS) ≤8, ICU stay ≥14 d, and indwelling catheter ≥30 d were independent risk factors for CAUTI in patients with traumatic brain injury(P<0.05). The nomogram model was constructed based on the multivariate analysis results of the derivation group and verified in both derivation group and validation group. The areas under the receiver characteristic curve(ROC) of the derivation group and the validation group were 0.944(95% CI: 0.922-0.965) and 0.930(95% CI: 0.898-0.963), respectively, with a good discrimination. The Hosmer lemeshow goodness-of-fit test results in the derivation group and the validation group showed that the calibration degree of the model was high(P=0.708 and P=0.831, respectively). CONCLUSION The nomo

关 键 词：神经外科 颅脑损伤 导尿管相关尿路感染 危险因素 列线图 

分 类 号：R651.15[医药卫生—外科学]