实体器官移植受者术后早期感染预测模型构建  

Construction of a predictive models for early postoperative infection in solid organ transplant recipients

作　　者：边沁 谈锦艳 陆雯静 潘凡祺 陈志强 李奕 黄怡 BIAN Qin;TAN Jin-yan;LU Wen-jing;PAN Fan-qi;CHEN Zhi-qiang;LI Yi;HUANG Yi(The First Affiliated Hospital of Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院疾病预防控制科,上海200433 [2]海军军医大学第一附属医院呼吸与危重症医学科,上海200433

出　　处：《中华医院感染学杂志》2024年第20期3079-3083,共5页Chinese Journal of Nosocomiology

基　　金：国家重点研发计划基金资助项目(2017YFC1309704)。

摘　　要：目的构建实体器官移植受者术后早期感染的预测模型。方法回顾性分析海军军医大学第一附属医院2020年1月-2023年7月157例器官移植受者的临床及实验室资料,利用逐步回归模型构建实体器官移植患者早期感染的预测模型。结果157例移植受者中,31例发生术后感染,感染率为19.75%;共检出病原菌57株,标本类型以痰为主(40.35%),检出病原菌以肠杆菌目、假单胞菌属、不动杆菌属和寡养单胞菌属为主;基于逐步回归结果构建感染预测模型:Logit(P)=-2.411+0.050×中心静脉插管时长+0.027×术后抗菌药物使用时长+0.064×导尿管使用时长-0.146×器官移植类型-0.398×高血压史;感染预测模型及Bootstrap内部验证的曲线下面积(AUC)为0.762(95%CI:0.684~0.840)和0.764(95%CI:0.686~0.843),当cutoff值为0.209时诊断灵敏度为83.33%、特异度为66.67%。结论实体器官移植术后早期感染以肠杆菌目感染为主,多指标联合诊断提高了模型预测性能。OBJECTIVE To construct a predictive model for early postoperative infection in solid organ transplant recipients.METHOD The clinical and laboratory data of 157 organ transplant recipients at the First Affiliated Hos-pital of Naval Medical University from Jan.2020 to Jul.2023 were retrospectively analyzed,and a stepwise regres-sion model was used to construct a predictive model for early infection in solid organ transplant patients.RESULTS Among the 157 transplant recipients,31 cases developed postoperative infections,with an infection rate of 19.75%.A total of 57 strains of pathogenic bacteria were detected,with sputum being the main type of specimen(40.35%).The top three pathogenic bacteria detected were Enterobacteriaceae(24.56%),Pseudomonas(17.54%),Acinetobacter(15.79%),and Stenotrophomonas(15.79%),respectively.An infection prediction model was constructed based on stepwise regression.RESULTS Logit(P)=-2.411+0.050×central venous cath-eterization duration+0.027×postoperative antibiotic use duration+0.064×catheter use duration-0.146×organ transplantation type-0.398×hypertension history.The area under the curve(AUC)of the infection prediction model and Bootstrap internal validation were 0.762(95%CI:0.684-0.840)and 0.764(95%CI:0.686-0.843),respectively.When the cutoff value was 0.209,the diagnostic sensitivity was 83.33%and the specificity was 66.67%.CONCLUSION Early postoperative infections after solid organ transplantation were mainly caused by Enterobacteriaceae infection,and the combination of multiple indicators improved the prediction performance of the model.

关 键 词：器官移植 早期感染 病原菌 列线图 预测模型 评价 

分 类 号：R619.3[医药卫生—外科学]