腹膜透析相关性腹膜炎患者住院时间延长危险因素分析及列线图构建  

Risk Factors and a Nomogram Construction for Prolonged Length of Hospital Stay in Patients With Peritoneal Dialysis Associated Peritonitis

作　　者：姚静[1] 鲍小健 张亚峰 伍彬 吴其顺 YAO Jing;BAO Xiaojian;ZHANG Yafeng;WU Bin;WU Qishun(Department of Public Health,Affiliated Hospital of Jiangsu University,Zhenjiang,Jiangsu 212000,China;Department of Medical Management,Affiliated Hospital of Jiangsu University,Zhenjiang,Jiangsu 212000,China;Department of Nephrology,Affiliated Hospital of Jiangsu University,Zhenjiang,Jiangsu 212000,China)

机构地区：[1]江苏大学附属医院公共卫生处,江苏镇江212000 [2]江苏大学附属医院医务处,江苏镇江212000 [3]江苏大学附属医院肾内科,江苏镇江212000

出　　处：《中国医学科学院学报》2025年第2期244-250,共7页Acta Academiae Medicinae Sinicae

基　　金：镇江市重点研发计划(SH2022079)。

摘　　要：目的分析腹膜透析相关性腹膜炎(PDAP)患者住院时间延长危险因素,并基于Logistic回归模型构建列线图。方法回顾性收集2013年1月1日至2023年12月31日在江苏大学附属医院收治的PDAP患者临床资料,以住院时间的第75百分位数为分界点(>21 d),将患者分为住院时间延长组和住院时间正常组,比较患者组间资料差异,采用多因素Logistic回归分析PDAP患者住院时间延长危险因素并构建列线图。结果共纳入131例PDAP患者,其中住院时间延长组40例,住院时间正常组91例。多因素Logistic回归分析显示,腹水检出革兰氏阴性菌(OR=6.012,95%CI=1.878~19.248,P=0.003)、血小板计数升高(OR=1.010,95%CI=1.005~1.015,P<0.001)是患者住院时间延长的独立危险因素,而血氯水平升高(OR=0.885,95%CI=0.802~0.978,P=0.016)是患者住院时间延长的保护因素。基于上述3项指标构建列线图,结果显示多因素Logistic回归模型预测患者住院时间延长的受试者工作特征曲线下面积为0.755,Bootstrap法内部验证受试者工作特征曲线下面积为0.727。校准曲线显示,模型预测概率与实际概率一致性较好。决策曲线显示,当阈值概率为9%~10%、13%和18%~92%时,模型具有临床适用性。结论基于腹水检出革兰氏阴性菌、血小板计数、血氯构建的列线图有助于临床筛选PADP住院时间延长患者,可为优化临床决策提供依据。Objective To analyze the risk factors for prolonged length of hospital stay in patients with peritoneal dialysis associated peritonitis(PDAP)and construct a nomogram based on Logistic regression model.Methods A retrospective study was conducted on patients with PDAP who were hospitalized at the Affiliated Hospital of Jiangsu University from January 2013 to December 2023.Using the 75th percentile of hospitalization time as the cutoff(>21 days),the patients were divided into prolonged length of hospital stay group and normal length of hospital stay group.Clinical data were compared between the two groups.Logistic regression analysis was used to analyze the risk factors for prolonged hospital stay in PDAP patients and to construct a nomogram.Results A total of 131 PDAP patients were included in this study,including 40 cases in prolonged length of hospital stay group and 91 cases in normal length of hospital stay group.Multivariate Logistic regression analysis showed that Gram-negative bacteria detected in ascites(OR=6.012,95%CI=1.878-19.248,P=0.003)and elevated platelet count(OR=1.010,95%CI=1.005-1.015,P<0.001)were independent risk factors for prolonged length of hospital stay,while elevated serum chloride(OR=0.885,95%CI=0.802-0.978,P=0.016)was a protective factor.Based on the above three indicators,a nomogram was constructed.The multivariate Logistic regression model showed an area under the receiver operating characteristic curve(AUC)of 0.755,with an internal validation AUC of 0.727 using the Bootstrap method.The calibration curve indicated that the predicted probability was consistent with the actual probability.The decision curve showed that the model was clinically applicable when the threshold probabilities were 9%-10%,13%and 18%-92%.Conclusion A nomogram,based on the detection of gram-negative bacteria in ascites,platelet count and serum chloride,was helpful for clinical screening PADP patients at risk for prolonged length of hospital stay,and can provide a basis for optimizing clinical decision-making.

关 键 词：腹膜透析相关性腹膜炎 住院时间延长 列线图 

分 类 号：R572[医药卫生—消化系统]