重症脑出血患者血流感染发生的影响因素分析及列线图预测模型构建  

Analysis of influencing factors and construction of nomogram prediction model for blood flow infection in patients with severe cerebral hemorrhage

作　　者：吴海燕[1] 向茉[1] Wu Haiyan;Xiang Mo(Department of Neurosurgery,Hainan Provincial People′s Hospital(Hainan Medical College Affiliated Hainan Hospital),Haikou 570311,China)

机构地区：[1]海南省人民医院(海南医科大学附属海南医院)神经外科,海口570311

出　　处：《中国医师进修杂志》2025年第4期298-304,共7页Chinese Journal of Postgraduates of Medicine

基　　金：海南省卫生健康行业科研项目(22A200015)。

摘　　要：目的分析重症脑出血患者血流感染发生的影响因素并构建列线图预测模型。方法回顾性收集2020年1月至2022年12月海南省人民医院收治的300例重症脑出血患者临床资料,根据住院期间血流感染发生情况分为感染组(22例)和未感染组(278例)。采用多因素Logistic回归分析重症脑出血患者血流感染发生的影响因素,构建预测重症脑出血患者血流感染发生的列线图模型,其内部验证采用校正曲线,预测效能采用决策曲线进行评估。结果感染组合并糖尿病、导管置管部位为股静脉、置管时间>7 d占比高于未感染组[45.45%(10/22)比20.14%(56/278)、68.18%(15/22)比32.37%(90/278)、63.64%(14/22)比40.29%(112/278)],血清白蛋白水平低于未感染组[(37.20±6.02)g/L比(42.12±4.46)g/L],差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,合并糖尿病、股静脉置管、置管时间>7 d为重症脑出血患者血流感染发生的危险因素,血清白蛋白水平高为重症脑出血患者血流感染发生的保护因素(P<0.05)。以糖尿病、导管置管部位、置管时间、血清白蛋白作为预测因子构建列线图模型,此模型预测重症脑出血患者发生血流感染的校正曲线趋近于理想曲线(一致性指数为0.865,95%CI 0.774~0.956);决策曲线分析结果显示,当风险阈值>0.08时,列线图模型提供的临床净收益高于糖尿病、导管置管部位、置管时间和血清白蛋白。结论合并糖尿病、股静脉置管、置管时间>7 d、血清白蛋白是重症脑出血患者血流感染发生的影响因素,且基于上述因素构建的列线图模型可用于识别血流感染高风险患者。ObjectiveTo analyze the influencing factors of blood flow infection in patients with severe cerebral hemorrhage and construct a nomogram prediction model.MethodsClinical data of 300 patients with severe cerebral hemorrhage admitted to the Hainan Provincial People′s Hospital from January 2020 to December 2022 were collected by retrospective study.According to the occurrence of bloodstream infection during hospitalization,they were divided into infected group(22 cases)and uninfected group(278 cases).Multivariate Logistic regression was used to analyze the influencing factors of the occurrence of blood flow infection in patients with severe cerebral hemorrhage,and a nomogram model was constructed to predict the occurrence of blood flow infection in patients with severe cerebral hemorrhage.The correction curve was used for internal verification,and the prediction efficiency was evaluated by decision curve.ResultsThe proportion of patients with diabetes,femoral vein catheterization,and catheterization time>7 d in the infected group was higher than that in the uninfected group group:45.45%(10/22)vs.20.14%(56/278),68.18%(15/22)vs.32.37%(90/278),63.64%(14/22)vs.40.29%(112/278),and the serum albumin level was lower than that in the uninfected group:(37.20±6.02)g/L vs.(42.12±4.46)g/L,with statistical significant differences(P<0.05).Multivariate Logistic regression analysis showed that diabetes,femoral vein catheterization,and catheterization time>7 d were risk factors for blood flow infection in patients with severe cerebral hemorrhage,and high serum albumin level was a protective factor for blood flow infection in patients with severe cerebral hemorrhage(P<0.05).The nomogram model was constructed with diabetes,catheter placement site,catheter placement time,and serum albumin as predictors.The calibration curve of this model for predicting blood flow infection in patients with severe intracerebral hemorrhage approached the ideal curve(C-index:0.865,95%CI:0.774 to 0.956).The result of decision curve analysis showed that

关 键 词：脑出血 血流感染 影响因素 列线图 

分 类 号：R743.34[医药卫生—神经病学与精神病学]