儿童铜绿假单胞菌血流感染的预后及影响因素分析  

Prognosis and influencing factors of Pseudomonas aeruginosa bloodstream infection in children

作　　者：鲁成刚 姚妹 朱履昌[2] 花旺[1] 华春珍[1] 黄丽素 Lu Chenggang;Yao Mei;Zhu Lyuchang;Hua Wang;Hua Chunzhen;Huang Lisu(Department of Infectious Diseases,Children's Hospital of Zhejiang University School of Medicine,Hangzhou 310052,China;PICU,Children's Hospital of Zhejiang University School of Medicine,Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院感染科,杭州310052 [2]浙江大学医学院附属儿童医院PICU,杭州310052

出　　处：《国际流行病学传染病学杂志》2023年第4期251-257,共7页International Journal of Epidemiology and Infectious Disease

摘　　要：目的探讨儿童铜绿假单胞菌血流感染预后影响因素,并构建生存列线图模型,为临床决策提供支持。方法纳入浙江大学医学院附属儿童医院于2018年6月至2022年6月就诊的67例铜绿假单胞菌血流感染患儿,按预后将患儿分为存活组(53例)和死亡组(14例),对其一般资料、临床特点和实验室指标进行分析,应用单因素及多因素Cox回归分析预后影响因素,应用R语言建立相应的列线图预测模型,并对模型的预测性与准确度进行验证。结果67例患儿主要分布于血液科(64.2%,43/67),其中30例(44.8%,30/67)为医院感染,54例(80.6%,54/67)存在基础疾病,以白血病最多见(62.7%,42/67),14例(20.9%,14/67)临床结局为死亡。与存活组相比,死亡组患儿C反应蛋白>150 mg/L、降钙素原>4.8 ng/mL、IL-6>2800 pg/mL、白蛋白≤29 g/L、耐碳青霉烯铜绿假单胞菌感染、皮肤损害及呼吸系统功能障碍发生率高,差异均有统计学意义(HR=5.55、3.28、7.62、6.84、4.62、3.83和12.08,P=0.004、0.034、0.002、0.003、0.006、0.031和0.017)。多因素Cox分析显示,IL-6>2800 pg/mL(HR=11.02,95%CI:1.93~62.96)、白蛋白≤29 g/L(HR=6.84,95%CI:1.43~32.70)、耐碳青霉烯铜绿假单胞菌感染(HR=6.56,95%CI:1.44~29.83)和呼吸系统功能障碍(HR=15.60,95%CI:1.37~177.96)是铜绿假单胞菌血流感染患儿死亡的独立危险因素。基于以上4项指标建立列线图模型,该模型的一致性指数为0.930,对10 d、20 d和30 d的生存预测效能分别为0.917、0.957和0.975。结论IL-6>2800 pg/mL、白蛋白≤29 g/L、耐碳青霉烯铜绿假单胞菌感染及呼吸系统功能障碍均为铜绿假单胞菌血流感染患儿死亡的独立危险因素,基于这4个危险因素建立的列线图模型预测效能高,有助于临床医师准确评估铜绿假单胞菌血流感染预后。ObjectiveTo explore the prognostic factors of Pseudomonas aeruginosa bloodstream infection in children,and build a survival nomogram model to provide support for clinical decisions.MethodsA total of 67 children with Pseudomonas aeruginosa bloodstream infection admitted to the Children’s Hospital of Zhejiang University School of Medicine from June 2018 to June 2022 were selected as research objects,and the children were divided into survival group(53 cases)and death group(14 cases)according to prognosis.Their general data,clinical characteristics and laboratory indicators were analyzed,and univariate and multivariate Cox regression were used to analyze the prognostic influencing factors.R language was used to establish a corresponding column diagram prediction model,and the predictability and accuracy of the model were verified.ResultsAmong 67 children,43 cases were mainly from hematology department(64.2%,43/67),30 cases(44.8%,30/67)had nosocomial infection,54 cases(80.6%,54/67)had underlying diseases with a high incidence of leukemia(62.7%,42/67),and 14 cases(20.9%,14/67)eventually died.Compared with the survival group,the death group had higher incidence rates of C-reactive protein>150 mg/L,procalcitonin>4.8 ng/mL,IL-6>2800 pg/mL,albumin≤29 g/L,carbapenem-resistant Pseudomonas aeruginosa infection,skin damage and respiratory dysfunction,and the differences were statistically significant(HR=5.55,3.28,7.62,6.84,4.62,3.83 and 12.08,P=0.004,0.034,0.002,0.003,0.006,0.031 and 0.017).Multivariate Cox analysis showed that IL-6>2800 pg/mL(HR=11.02,95%CI:1.93-62.96),albumin≤29 g/L(HR=6.84,95%CI:1.43-32.70),carbapenem-resistant Pseudomonas aeruginosa infection(HR=6.56,95%CI:1.44-29.83)and respiratory dysfunction(HR=15.60,95%CI:1.37-177.96)were independent risk factors for death in children with Pseudomonas aeruginosa bloodstream infection.Based on the above four indicators,the nomogram model was established.The consistency index of the model was 0.930,and the prediction efficiency of survival at 10 d,20 d and 30 d we

关 键 词：铜绿假单胞菌 儿童 血流感染 预后 危险因素 列线图 预测 

分 类 号：R725.1[医药卫生—儿科]