上臂输液港相关感染危险因素分析和预测模型构建  

Profiling of the risk factors and a prediction model for upper arm port related infections

作　　者：张梦肃 许晟熙 张杰 金光鑫[2] 张学彬[2] 卜军[1] ZHANG Mengsu;XU Shengxi;ZHANG Jie;JIN Guangxin;ZHANG Xuebin;PU Jun(Department of Cardiology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院心内科,上海200127 [2]上海交通大学医学院附属仁济医院肿瘤介入科,上海200127

出　　处：《中国感染与化疗杂志》2025年第2期140-148,共9页Chinese Journal of Infection and Chemotherapy

摘　　要：目的 开发和验证上臂输液港相关感染的预测模型。方法 纳入上海交通大学附属仁济医院2014-2023年置入上臂输液港的患者(n=6 028),并将其分为训练集(n=4 219)和验证集(n=1 809)。对收集的上臂输液港相关因素进行最小绝对收缩和选择算子回归,筛选出非零特征变量。采用多元logistic回归分析非零特征变量,筛选出的变量建立预测模型。在训练集和验证集中,通过受试者工作特征曲线的曲线下面积、校准曲线、决策分析曲线和临床影响曲线对模型性能进行评估。结果 模型纳入了性别、静脉入路、静脉状态、导管相关血栓和导管直径5个因素。模型性能良好:受试者工作特征曲线的曲线下面积值良好(训练集:0.801,验证集:0.746);校准曲线接近理想曲线,模型判别能力良好;决策分析曲线证明模型的风险评估值在30%~41%时可做出有益的临床决策;临床影响曲线表明模型具有良好的临床价值。结论 成功构建预测上臂输液港相关感染的模型,建议首选直径5F导管并优选肱静脉或贵要静脉作为静脉穿刺入路。较粗的导管直径、男性、导管血栓以及经腋静脉入路均可能导致感染风险增加。Objective To analyze the risk factors for upper arm ports(UAP)related infections and develop a nomogram for predicting the UAP related infections.Methods Patients(n=6028)with UAP between 2014 and 2023 in Renji Hospital,Shanghai Jiao Tong University School of Medicine were included and assigned to a training set(n=4219)or a validation set(n=1809).Least Absolute Shrinkage and Selection Operator(LASSO)regression were built and non-zero factors were screened out.Multivariate logistic regression was performed for these non-zero factors to screen significant factors out for constructing a prediction model.The performance of the model was evaluated by the area under curve(AUC)of the receiver operating characteristic(ROC)curves,calibration curves,the decision curve analysis(DCA)curve,and clinical impact curves(CICs)in both training set and validation set.Results The model incorporated gender,venous access,venous status,catheter-related thrombosis(CRT),and diameter of catheter.The model performed well.The AUC of ROC was 0.801 in the training set and 0.746 in the validation set.The calibration curve was close to the ideal curve,indicating good discriminative ability of the model.The DCA curve suggested that the model could help make beneficial clinical decisions when the risk assessment value was 30%-41%.CICs proved that the model had good clinical value.Conclusions A model was successfully constructed to predict UAP-related infections.The brachial/basilic vein and 5F catheter was proposed as the first choice.Thicker catheter diameter,male,CRT,abnormal venous status,and axillary vein approach may increase the risk of UAP related infection.

关 键 词：上臂输液港 感染 预测模型 

分 类 号：R472[医药卫生—护理学] R51[医药卫生—临床医学]