乙肝肝硬化患者医院感染危险因素及多因素Logistic风险预测模型的构建与验证  

Construction and verification of nosocomial infection risk factors and multivariate Logistic risk prediction model in patients with hepatitis B and cirrhosis

作　　者：陈晓君 陈肖漪 陈红[1] 顾李琴[1] CHEN Xiaojun;CHEN Xiaoyi;CHEN Hong;GU Liqin(Department of Infection Management,Affiliated Hospital of Nantong University,Nantong,Jiangsu,226001,China;Department of Gastroenterology,Affiliated Hospital of Nantong University,Nantong,Jiangsu,226001,China)

机构地区：[1]南通大学附属医院感染管理科,江苏南通226001 [2]南通大学附属医院消化内科,江苏南通226001

出　　处：《当代医学》2024年第14期1-4,共4页Contemporary Medicine

基　　金：江苏省医院协会医院管理创新研究项目(JSYGY-3-2020-187);南通市科技计划基金项目(MSZ20157、MSZ2022134);南通市卫生和计划生育委员会科研项目(QA2020066、QN2022013)。

摘　　要：目的分析乙肝肝硬化患者医院感染的危险因素,构建医院感染的风险预测模型,为临床制定预防措施提供依据。方法回顾性分析2015年1月至2020年12月南通大学附属医院收治的126例乙肝肝硬化患者的临床资料,统计医院感染发生情况。采用单因素及多因素Logistic回归分析乙肝肝硬化患者发生医院感染的危险因素,并构建医院感染风险预测模型,绘制ROC曲线评估模型的预测效果。结果126例乙肝肝硬化患者中,发生医院感染42例,以呼吸系统为主(66.67%)。单因素分析结果显示,感染与未感染患者Child-Pugh肝功能分级、并发症发生率、使用广谱抗菌药物情况、胆红素水平、血清白蛋白水平及住院时间比较差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,胆红素≥17.1 mol/L、血清白蛋白<30 g/L、使用广谱抗菌药物是乙肝肝硬化患者发生医院感染的独立危险因素(P<0.05)。经Hosmer-Lemeshow检验,乙肝肝硬化患者发生医院感染的风险预测模型拟合度较好(P>0.05),ROC曲线分析结果显示,风险预测模型预测乙肝肝硬化患者发生医院感染的效能较好(AUC=0.816,95%CI:0.739~0.893,P<0.05)。结论胆红素≥17.1 mol/L、血清白蛋白<30 g/L、使用广谱抗菌药物是乙肝肝硬化患者发生医院感染的独立危险因素,构建多因素Logistic风险预测模型能准确预测乙肝肝硬化患者发生医院感染的危险因素,有利于临床及时识别易感人群,提前采取有效的干预措施,降低医院感染率。Objective To analyze the risk factors of nosocomial infection in patients with hepatitis B and cirrhosis,and to construct a risk prediction model of nosocomial infection,so as to provide a basis for clinical formulation of preventive measures.Methods The clinical data of 126 patients with hepatitis B cirrhosis admitted to the Affiliated Hospital of Nantong University from January 2015 to December 2020 were retrospectively analyzed,the incidence of nosocomial infections was counted.Univariate and multivariate Logistic regression were used to analyze the risk factors of nosocomial infection in patients with hepatitis B cirrhosis,and a nosocomial infection risk prediction model was constructed,ROC curve was drawn to evaluate the predictive effect of the model.Results Among 126 patients with hepatitis B cirrhosis,42 cases of nosocomial infection occurred,mainly respiratory system(66.67%).Univariate analysis showed that there were statistically significant differences in Child-Pugh liver function grade,complications rates,use of broad-spectrum antibiotics,bilirubin level,serum albumin level and length of hospital stay between the infect-ed and uninfected patients(P<0.05).Multivariate Logistic regression analysis result showed that bilirubin≥17.1 mol/L,serum albumin<30 g/L,and use of broad-spectrum antibiotics were independent risk factors for nosocomial infection in patients with hepatitis B cirrhosis(P<0.05).Hosmer-Lemeshow test showed that the risk prediction model of nosocomial infection in patients with hepatitis B cirrhosis has good model fit(P>0.05),and ROC curve analysis results showed that the Risk prediction models had better predictive efficacy in predicting nosocomial infection in patient s with hepatitis B cirrhosis(AUC=0.816,95%CI:0.739-0.893,P<0.05).Conclusion Bilirubin≥17.1 mol/L,serum albumin<30 g/L,and use of broad-spectrum antibiotics were independent risk factors for nosocomial infection in patients with hepatitis B cirrhosis,the construction of a multi factor Logistic risk prediction model can

关 键 词：乙肝肝硬化 医院感染 危险因素 风险预测模型 

分 类 号：R575.2[医药卫生—消化系统]