血液透析患者中心静脉导管相关性感染的危险因素及预测模型构建  

Risk factors for central venous catheter-related infections in hemodialysis patients and establishment of predication model

作　　者：武燕[1] 师璟 陆伟锋 武晓圆 WU Yan;SHI Jing;LU Wei-feng;WU Xiao-yuan(Fenyang College of Shanri Medical University,Fenyang,Shanri 032200,China)

机构地区：[1]山西医科大学汾阳学院山西省汾阳医院肾内科,山西汾阳032200

出　　处：《中华医院感染学杂志》2024年第10期1584-1588,共5页Chinese Journal of Nosocomiology

基　　金：山西省科研基金资助项目(2021HG02140)。

摘　　要：目的探讨血液透析(HD)患者中心静脉导管相关性感染(CVC-RI)的危险因素。方法选取2019年1月-2022年12月在山西省汾阳医院接受治疗的HD患者240例,收集所有患者的临床资料并进行回顾性分析,将发生CVC-RI的患者纳入感染组(40例),未发生CVC-RI的患者纳入非感染组(200例)。分析两组患者临床资料,采用Lasso--Logistic回归分析法进行HD患者CVC-RI的危险因素分析,并进行预测模型构建,通过绘制受试者工作特征(ROC)曲线分析模型的预测价值。结果Lasso--Logistic回归分析结果显示,HD患者CVC-RI的危险因素包括合并糖尿病、临时导管(P<0.05),全血Hb水平≥90 g/L是HD患者CVC-RI的保护因素(P<0.05);构建的回归方程模型:Logit(P)=-1.872+导管类型×1.191+合并糖尿病×1.403-全血Hb水平×2.041,ROC曲线分析显示,当Logit(P)>0.226时,曲线下面积(AUC)值为0.837,95%CI为0.773~0.900,诊断敏感度为87.50%,特异度为68.50%。结论HD患者CVC-RI的危险因素包括临时导管、合并糖尿病,而全血Hb水平≥90 g/L是HD患者CVC-RI的保护因素,临床可据此给予针对性的预防措施。OBJECTIVE To explore the risk factors for central venous catheter(CVC)-related infections in hemodialysis(HD)patients.METHODS A total of 240 HD patients who were treated in Fenyang Hospital from Jan 2019 to Dec 2022 were enrolled in the study,the clinical data were collected from all of the patients and were retrospectively analyzed,40 patients who had CVC-related infection were assigned as the infection group,and 200 patients who did not have CVC-related infection were assigned as the non-infection group.The clinical data of the two groups of patients were analyzed,Lasso-Logistic regression analysis was performed for the risk factors for the CVC-related infections in the HD patients,the prediction model was established,and the predictive value of the model was analyzed by means of receiver operating characteristic(ROC)curves.RESULTS The result of Lasso-Logistic regression analysis showed that the risk factors for the CVC-related infection in the HD patients included complication with diabetes mellitus and temporary catheters(P<0.05),and the whole blood Hb no less than 90 g/L was the protective factor for the CVC-related infection in the HD patients(P<0.05).The established regression equation model was as follows:Logit(P)=-1.872+type of catheter×1.191+complication with diabetes mellitus×1.403-whole blood Hb×2.041.ROC curve analysis indicated that when Logit(P)was more than 0.226,the area under curve(AUC)was 0.837,95%CI was 0.773-0.900,with the sensitivity 87.50%,the specificity 68.50%.CONCLUSION The risk factors for the CVC-related infection in the HD patients include the temporary catheter and complication with diabetes mellitus,while the whole blood Hb no less than 90 g/L is the protective factor.It is necessary for the hospital to take targeted prevention measures.

关 键 词：血液透析 中心静脉导管相关性感染 危险因素 受试者工作特征曲线 预测模型 

分 类 号：R459.5[医药卫生—治疗学]