ICU耐碳青霉烯类鲍曼不动杆菌血流感染患者生存率的预测模型构建  

Construction of a predictive model for death in patients with carbapenem-resistant Acinetobacter baumannii bloodstream infection

作　　者：易思婷 刘平娟 叶梦敏 曾今诚 YI Siting;LIU Pingjuan;YE Mengmin;ZENG Jincheng(Guangdong Medical University/Guangdong Key Laboratory of Medical Immunology and Molecular Diagnosis/Dongguan Key Laboratory of Medical Active Molecule Development and Transformation,Dongguan,Guangdong 523808,China;Department of Laboratory Medicine,the First Afliated Hospital,Sun Yat-sen University,Guangzhou,Guangdong 510080,China)

机构地区：[1]广东医科大学/广东省医学免疫与分子诊断重点实验室/东莞市医学活性分子开发与转化重点实验室,广东东莞523808 [2]中山大学附属第一医院医学检验科,广州510080

出　　处：《重庆医学》2025年第4期884-888,共5页Chongqing Medical Journal

基　　金：广东省自然科学基金项目(2024A1515012831);广东省东莞市社会科技发展重点项目(20221800905612)。

摘　　要：目的探讨重症监护室(ICU)病区耐碳青霉烯类鲍曼不动杆菌(CRAB)血流感染(BSI)患者发生死亡的危险因素,并构建列线图预测模型。方法回顾性分析该院2018年1月1日至2023年12月31日ICU病区CRAB BSI患者的病历资料,采用Cox回归分析CRAB BSI患者发生死亡的危险因素,并构建列线图预测模型。通过绘制校准曲线、受试者工作特征(ROC)曲线及一致性指数(C-index)评价列线图预测模型的预测能力。结果发生感染性休克(HR=7.770,95%CI:1.852~32.593)是CRAB BSI患者死亡的独立危险因素,住院时间>14 d(HR=0.331,95%CI:0.165~0.665)是其独立保护因素。基于以上因素构建列线图模型,C-index为0.725(95%CI:0.652~0.798),对患者20 d、30 d生存率的预测效能分别为0.831(95%CI:0.752~0.910)、0.826(95%CI:0.715~0.937),校准曲线拟合良好。结论构建的列线图预测模型对CRAB BSI患者的生存率有较好的预测价值。Objective To investigate the risk factors for carbapenem-resistant Acinetobacter baumannii(CRAB)bloodstream infection in intensive care units(ICU)and construct a nomogram prediction model.Methods A retrospective analysis was conducted on the medical records of patients with CRAB bloodstream(BSI)infection in the ICU ward of the First Afliated Hospital,Sun Yat-sen University from January 1,2018 to December 31,2023.Cox regression analysis was usedo determine the risk factors for death in patients with CRAB bloodstream infection and to construct a nomogram.prediction model.The predictive ability of the nomogramprediction model was evaluated by drawing calibration curves,receiver operating characteristic(ROC)curves,and consistency index(C-index).Results Septic shock(HR=7.770,95%CI:1.852-32.593)was an independent risk factor for mortality in patients with CRAB bloodstream infections,and hospitalisation day>14 d(HR=0.331,95%CI:0.165-0.665)was an independent protective factor for mortality in patients with CRAB bloodstream infections.A nomogram was constructed based on the above factors,with a C-index of 0.725(95%CI:0.652-0.798).The predictive efficacy of patient survival rates at 20 d and 30 d was 0.831(95%CI:0.752-0.910)and 0.826(95%CI:0.715-0.937),respectively.The calibration curve was well fitted.Conclusion Septic shock was an independent risk factor for mortality in patients with CRAB bloodstream infections,and hospitalisation days>14 d was an independent protective factor for mortality in patients CRAB BSI infections.The nomogram prediction model constructed accordingly has good predictive value for the survival rate of patients in the intensive care unit who undergo CRAB bloodstream infections.

关 键 词：耐碳青霉烯类鲍曼不动杆菌 血流感染 危险因素 列线图 预测模型 

分 类 号：R446.5[医药卫生—诊断学]