早产极低体重儿医院感染发生风险预测模型的建立  

Establishment of risk prediction model for nosocomial infection in preterm very low birth weight infants

作　　者：胡园园 刘亚 何娇[1] 杨雪娇[1] 刘珍珍 HU Yuanyuan;LIU Ya;HE Jiao;YANG Xuejiao;LIU Zhenzhen(Department of Neonatology,Union Hospital Affiliated to Tongji Medical College,Huazhong University of science and technology,Wuhan,Hubei 430000,China)

机构地区：[1]华中科技大学同济医学院附属协和医院新生儿科,湖北武汉430000

出　　处：《中国热带医学》2023年第9期971-976,1001,共7页China Tropical Medicine

摘　　要：目的 建立早产极低体重儿医院感染发生风险预测模型,并进行内部验证。方法 选择2018年1月—2020年6月在华中科技大学同济医学院附属协和医院新生儿科住院的早产极低体重儿206例,收集可能影响患儿院内感染的因素,根据有无医院感染分为2组,比较2组患儿各影响因素,以LASSO回归筛选变量后行多因素Logistic回归分析。根据多因素分析结果构建列线图模型,并进行内部验证。结果 206例患儿中共29例出现医院感染(14.08%),病原菌共检出33株,其中革兰阴性菌23株,革兰阳性菌9株,真菌1株。LASSO回归基础上多因素Logistic回归分析结果显示:出生孕周28~31^(+6)周、羊水有污染、机械通气、留置胃管、抗菌药物使用不合理、住院时间≥7 d为早产极低体重儿医院感染的危险因素,1 min Apgar评分≥7分、母乳喂养占比50%及以上为保护性因素(P<0.05)。列线图模型受试者工作特征曲线(receiver operating characteristic curve,ROC)曲线下面积(area under curve,AUC)为0.946[95%CI(0.923,1.000)]。校准曲线显示模型预测早产极低体重儿医院感染的概率与实际概率基本吻合。决策曲线显示当列线图模型预测早产极低体重儿医院感染风险的概率值为0~0.85时,净收益率大于0。结论 早产极低体重儿医院感染发生风险较高,主要受出生孕周、住院时间、羊水污染情况等因素的影响,上述因素构建的列线图模型预测此类患儿医院感染具有较高的准确度与区分度。Objective To establish a risk prediction model for nosocomial infection in preterm very low birth weight infants,and conduct internal validation.Methods A total of 206 cases of very low birth weight premature infants hospitalized in the Department of Neonatology of Union Hospital Affiliated to Tongji Medical College from January 2018 to June 2020 were included in this study,factors that may affect the nosocomial infection of children were collected,and the infants were divided into two groups according to whether there is nosocomial infection.The influencing factors were compared between the two groups,and multivariate Logistic regression analysis was performed after screening variables with LASSO regression.According to the results of multi factor analysis,the nomogram model was constructed and verified internally.Results A total of 29 of 206 children had nosocomial infection(14.08%),and 33 pathogenic bacteria were detected,including 23 Gram-negative bacteria,9 Gram-positive bacteria and 1 fungus.The results of multivariate logistic regression analysis based on LASSO regression showed that the risk factors for nosocomial infection of VLBW premature infants were 28-31^(+6) weeks of gestation,amniotic fluid pollution,mechanical ventilation,indwelling gastric tube,unreasonable use of antibiotics,and hospitalization time≥7 days.The protective factors were Apgar score≥7 points at 1 min and breast feeding accounting for 50%or more(P<0.05).The Area Under Curve(AUC)of ROC curve of nomogram model was 0.946[95%CI(0.923,1.000)].The calibration curve showed that the probability of hospital infection predicted by the model was basically consistent with the actual probability.The decision curve showed that when the probability threshold of nomogram model to predict the risk of nosocomial infection of very low birth weight premature infants was 0-0.85,the net rate of return was greater than 0.Conclusion Preterm infants with extremely low birth weight are at high risk of nosocomial infection,mainly affected by factors such

关 键 词：早产极低体重儿 院内感染 多因素分析 列线图模型 

分 类 号：R722.6[医药卫生—儿科]