慢性肾衰竭患者发生抗生素脑病的预测模型的建立和评价  

Establishment and evaluation of prediction model for antibiotic-associated encephalopathy in patients with chronic renal failure

作　　者：余建峰 金劲松[2] 龙利 徐敏 金晟 张继波 刘浩[1] Yu Jianfeng;Jin Jinsong;Long Li;Xu Min;Jin Sheng;Zhang Jibo;Liu Hao(Department of Nephrology,Hubei No.3 People′s Hospital Affiliated to Jianghan University,Wuhan 430030;Department of Nephrology,Hubei Provincial Hospital of Traditional Chinese Medicine,Wuhan 430070,Hubei Province,China)

机构地区：[1]江汉大学附属湖北省第三人民医院肾病科,武汉430030 [2]湖北省中医院肾病科,武汉430070

出　　处：《中华肾病研究电子杂志》2023年第1期1-7,共7页Chinese Journal of Kidney Disease Investigation（Electronic Edition）

基　　金：2021年湖北省卫生健康委员会科研项目(ZY2021M071)。

摘　　要：目的探讨慢性肾衰竭(CRF)患者发生抗生素相关性脑病(AAE)的危险因素,并建立预测模型。方法回顾性分析784例CRF患者的临床资料,所有患者均使用了抗生素治疗,根据患者有无发生AAE,分为AAE组(103例)和非AAE组(681例),将两组患者有统计学意义的临床指标纳入Logistic回归分析,得出AAE发生的独立危险因素并建立预测模型,并使用列线图展示模型。采用ROC曲线、校准曲线判定该模型的区分度及校准度,使用Bootstrap法对模型进行内部验证。结果多变量Logistic回归分析显示,年龄大(OR 1.033,95%CI:1.012~1.054)、低血浆白蛋白(OR 0.852,95%CI:0.802~0.905)、低GFR(OR 0.963,95%CI:0.940~0.988)、单用β-内酰胺酶抑制剂复方制剂类抗生素(OR 3.827,95%CI:1.528~9.584)、两种或两种以上抗生素联用(OR 2.913,95%CI:1.187~7.149)以及抗生素未减量使用(OR 0.343,95%CI:0.212~0.553)均为CRF患者发生AAE的独立影响因素。列线图模型的ROC曲线下面积为0.808(95%CI:0.770~0.846),内部验证C-统计量0.808。结论本研究建立的预测模型可对临床上早期识别CRF患者的AAE风险及实施预防性措施提供一定参考价值。Objective To explore the risk factors of the occurrence of antibiotic-associated encephalopathy(AAE)in patients with chronic renal failure(CRF)and establish a prediction model.Methods The clinical data of 784 patients with CRF were retrospectively analyzed.All the patients had received treatment of antibiotics.According to whether the patients had AAE or not,they were divided into AAE group(n=103)and non-AAE group(n=681).The clinical indicators with statistical differences between the two groups were included in logistic regression analysis to obtain the independent risk factors of AAE and establish a prediction model which was shown by the nomogram.Receiver operating characteristic(ROC)curve and calibration curve were used to assess the discrimination and calibration of the model,and Bootstrap method was used for internal validation.Results The multivariate logistic regression analysis showed that aging(OR 1.033,95%CI:1.012-1.054),low plasma albumin(OR 0.852,95%CI:0.802-0.905),low GFR(OR 0.963,95%CI:0.940-0.988),separate use ofβ-lactamase inhibitor compound preparation antibiotic(OR 3.827,95%CI:1.528-9.584),combination of two or more antibiotics(OR 2.913,95%CI:1.187-7.149),and use of antibiotics without dose reduction(OR 343,95%CI:0.212-0.553)were all independent influencing factors for the occurrence of AAE in CRF patients.The area under the ROC curve(AUC)of the nomogram model was 0.808(95%CI:0.770-0.846)with an internal verification C-index of 0.808.Conclusion The prediction model established in this study may provide some reference value for the early identification of AAE risk and the implementation of preventive measures in CRF.

关 键 词：慢性肾衰竭 抗生素相关性脑病 危险因素 预测模型 

分 类 号：R692.5[医药卫生—泌尿科学]