重症急性胰腺炎并发多药耐药菌感染影响因素及预测模型建立  被引量:4

Influencing factors of multidrug-resistant organism infection in severe acute pancreatitis and construction of prediction model

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作  者:张宁[1] 胡志硕 王智超[1] 陈慰 苏清 ZHANG Ning;HU Zhi-shuo;WANG Zhi-chao;CHEN Wei;SU Qing(Wuhan First Hospital,Wuhan,Hubei 430022,China)

机构地区:[1]武汉市第一医院急诊医学科,湖北武汉430022

出  处:《中华医院感染学杂志》2023年第4期562-566,共5页Chinese Journal of Nosocomiology

基  金:湖北省自然科学基金资助项目(2019H117)。

摘  要:目的 探究重症急性胰腺炎(SAP)患者并发多药耐药菌(MDRO)感染的影响因素并建立预测模型.方法 回顾性分析2019年1月-2021年8月于武汉市第一医院接受治疗的SAP患者80例,按照是否并发MDRO感染分为两组,感染组患者19例、未感染组61例;并构建预测模型,采用受试者工作特征(ROC)曲线分析此模型的预测价值.结果 感染组患者的年龄大于未感染组(P<0.05),感染组患者脓毒症并发症发生率、SAPⅡ级占比、入院时急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分、CT危重度(CTSI)评分以及入院时白细胞(WBC)计数均高于未感染组(P<0.05),感染组患者中心静脉导管留置、ICU住院以及总住院时间均长于未感染组(P<0.05);Logistic回归分析显示,入院时APACHE Ⅱ评分、CTSI评分为SAP患者并发MDRO感染的影响因素(P<0.05);预测模型方程式为Log=-42.917+(1.501入院时APACHE Ⅱ评分)+(1.677 CTSI评分),ROC分析显示,Hosemer-Lemeshow检验此模型的约登指数为0.796,预测曲线下面积(AUC)为0.953(P<0.05).结论 SAP患者MDRO易感性与患者的并发症、疾病进展以及ICU住院时间等诸多因素有关,临床治疗中可根据患者的实际情况预测患者MDRO感染概率,提前采取预防措施,改善患者预后.OBJECTIVE To investigate the influencing factors of multidrug-resistant organism(MDRO)infection in patients with severe acute pancreatitis(SAP),and to develop a predictive model.METHODS A total of 80 patients with SAP treated at Wuhan First Hospital from Jan.2019 to Aug.2021 were retrospectively analyzed,and divided into two groups according to the presence or absence of MDRO infection,19 patients in the infection group and 6l patients in the non-infection group.A prediction model was constructed,and its predictive value was analyzed using the receiver operating characteristic(ROC)curve.RESULTS Patients in the infection group were older than those in the non-infection group(P<0.05).The incidence of complications,the proportion of grade Ⅱ SAP,the acute physiology and chronic health evaluation Ⅱ(APACHEII)score at admission,CT severity index(CTSI)score,and white blood cell(WBC)count at admission in the infection group were higher than those in the non-infection group(P<0.05).The central venous catheter indwelling time,length of ICU stay and total length of hospital stay of the infection group were longer than those of the non-infection group(P<0.05).Logistic regression analysis showed that APACHEⅡ score at admission and CTSI score were influencing factors of MDRO infection in patients with SAP(P<0.05).The equation of the predictive model was Log=-42.917+(1.501 APACHEⅡ score at admission)+(1.677 CTSI score).ROC analysis showed that the Hosemer-Lemeshow test for this model had a Youden index of 0.796,and the area under the curve(AUC)of prediction was 0.953(P<0.05).CONCLUSION The susceptibility of patients with SAP to MDRO was related to many factors such as complications,disease progression and length of ICU stay.In clinical treatment,the probability of MDRO infection could be predicted according to the patient's actual condition,and preventive measures should be taken in advance to improve the prognosis.

关 键 词:重症急性胰腺炎 多药耐药菌感染 影响因素 预测模型 

分 类 号:R657.51[医药卫生—外科学]

 

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