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慢加急性肝衰竭患者发生肺部感染的危险因素及预测模型的构建

王李晶子 李沛 张野 连建奇 张岚 吴沙沙 石聪敏 党肖

引用本文:
Citation:

慢加急性肝衰竭患者发生肺部感染的危险因素及预测模型的构建

DOI: 10.12449/JCH240620
基金项目: 

空军军医大学第二附属医院社会人才基金资助计划项目 (2021SHRC057)

伦理学声明: 本研究方案于2022年11月30日经由空军军医大学第二附属医院伦理委员会审批通过,批号:第K202211-34号。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:党肖、王李晶子负责设计论文框架,起草论文;张岚、石聪敏、吴沙沙负责数据收集;王李晶子负责数据分析、绘制图表;李沛、张野负责论文修改;张野、连建奇负责拟定写作思路,指导撰写文章并最后定稿。
详细信息
    通信作者:

    党肖, 513307098@qq.com (ORCID: 0000-0001-5124-8047)

Risk factors for pulmonary infection in patients with acute-on-chronic liver failure and establishment of a predictive model

Research funding: 

Social Talent Fund Program of the Second Affiliated Hospital of Air Force Medical University (2021SHRC057)

More Information
    Corresponding author: DANG Xiao, 513307098@qq.com (ORCID: 0000-0001-5124-8047)
  • 摘要:   目的  分析慢加急性肝衰竭(ACLF)患者发生肺部感染的危险因素,并构建预测模型。  方法  回顾性选取2009年1月—2022年9月空军军医大学第二附属医院传染科收治的585例ACLF患者为研究对象。根据患者入院后肺部感染情况,分为感染组(213例)和未感染组(372例),回顾性收集患者临床资料。计量资料两组间比较采用成组t检验或Mann-Whitney U检验。计数资料组间比较采用χ2检验。单因素及多因素Logistic回归分析筛选ACLF患者发生肺部感染危险因素并建立预测模型,绘制受试者工作特征曲线(ROC曲线)分析模型的预测价值。采用Hosmer-Lemeshow检验评估模型拟合度,采用ROC曲线及曲线下面积(AUC)评估模型的预测效能。  结果  585例ACLF患者发生肺部感染213例,感染率为36.41%;多因素Logistic回归分析结果显示,合并上消化道出血(OR=2.463,P=0.047)、合并其他部位感染(OR=2.218,P=0.004)、股静脉置管(OR=2.520,P<0.001)及联合使用≥2种抗生素(OR=2.969,P<0.001)为ACLF患者发生肺部感染的危险因素;将上述因素纳入建立危险因素预测模型:Logit(P)=-1.869+0.901×合并上消化道出血+0.755×合并其他部位感染+0.924×股静脉置管+1.088×联合使用≥2种抗生素,ROC曲线提示预测较好,AUC为0.753,95%CI为0.700~0.772。Hosmer-Lemeshow检验结果为χ2=3.839,P=0.698。  结论  ACLF患者肺部感染发生率较高,合并上消化道出血、合并其他部位感染、股静脉置管及联合使用≥2种抗生素是其危险因素,构建的危险因素模型可较好的预测ACLF患者肺部感染的发生。

     

  • 图  1  ACLF患者肺部感染ROC曲线

    Figure  1.  ROC curves of the risk factor model in prediction of pulmonary infection patients with ACLF

    表  1  两组ACLF患者基线特征及单因素分析结果

    Table  1.   Baseline characteristics and univariate analysis results of two groups of ACLF patients

    因素 感染组(n=213) 非感染组(n=372) 统计值 P值
    男/女(例) 134/79 259/113 χ2=2.768 0.096
    年龄(岁) 47.95±13.76 47.53±13.72 t=-0.354 0.723
    BMI(kg/m2 23.47±3.73 23.58±3.57 t=-0.365 0.715
    吸烟史[例(%)] 66(30.99) 85(22.85) χ2=4.683 0.030
    饮酒史[例(%)] 70(32.86) 90(24.19) χ2=5.124 0.024
    意识清醒[例(%)] 184(86.38) 331(88.98) χ2=0.865 0.352
    有自理能力[例(%)] 112(52.58) 211(56.72) χ2=0.938 0.333
    自主体位[例(%)] 193(90.61) 336(90.32) χ2=0.013 0.909
    合并基础疾病[例(%)]
    高血压 14(6.57) 28(7.53) χ2=0.185 0.667
    糖尿病 34(15.96) 52(13.98) χ2=0.425 0.514
    心血管疾病史 13(6.10) 31(8.33) χ2=0.968 0.325
    胃部疾病史 27(12.68) 48(12.90) χ2=0.006 0.937
    肝衰竭分期[例(%)] χ2=0.629 0.890
    前期 28(13.15) 53(14.25)
    早期 中期 晚期 69(32.39) 62(29.11) 54(25.35) 125(33.60) 110(29.57) 84(22.58)
    肺部感染前其他诊断[例(%)]
    上消化道出血 24(11.27) 21(5.65) χ2=6.030 0.014
    肝性脑病 97(45.54) 110(29.57) χ2=15.109 <0.001
    腹水 187(87.79) 269(72.31) χ2=18.887 <0.001
    合并其他部位感染[例(%)] 138(64.79) 126(33.87) χ2=52.286 <0.001
    真菌感染[例(%)] 16(7.51) 5(1.34) χ2=14.887 <0.001
    肺部感染前侵入性操作[例(%)]
    吸痰 25(11.74) 24(6.45) χ2=4.930 0.026
    中心静脉置管 14(6.57) 15(4.03) χ2=1.855 0.173
    股静脉置管 80(37.56) 65(17.47) χ2=29.311 <0.001
    尿管 75(35.21) 78(20.97) χ2=14.228 <0.001
    胃管 35(16.43) 29(7.80) χ2=10.368 <0.001
    灌肠 130(61.03) 154(41.40) χ2=20.908 <0.001
    肺部感染前治疗措施[例(%)]
    人工肝 140(65.73) 157(42.20) χ2=29.987 <0.001
    机械通气 29(13.62) 16(4.30) χ2=16.548 <0.001
    使用激素 176(82.63) 238(63.98) χ2=22.776 <0.001
    联合使用≥2种抗生素 148(69.48) 149(40.05) χ2=46.936 <0.001
    入院首次实验室指标
    Alb(g/L) 30.20(26.80~33.50) 31.10(27.30~34.70) Z=-1.415 0.157
    ALT(U/L) 88.50(42.25~341.00) 158.00(49.50~463.75) Z=-2.174 0.030
    AST(U/L) 114.00(54.50~351.00) 158.00(64.00~488.00) Z=-2.052 0.040
    TBil(μmol/L) 336.38±164.97 297.53±166.89 t=-2.470 0.014
    Scr(μmol/L) 59.00(48.78~74.25) 57.40(47.00~73.00) Z=-0.419 0.675
    WBC(×109/L) 6.41(4.26~9.23) 5.81(4.22~7.75) Z=-1.639 0.101
    ANC(×109/L) 4.49(2.78~7.24) 3.99(2.56~6.11) Z=-1.848 0.065
    Hb(g/L) 113.00(87.00~135.00) 123.00(93.00~139.50) Z=-2.260 0.054
    PLT(×109/L) 73.00(44.00~126.25) 81.00(38.00~136.00) Z=-0.928 0.354
    PTA(%) 34.05(23.80~42.60) 37.40(26.45~49.30) Z=-2.638 0.008
    INR 1.93(1.58~2.72) 1.84(1.52~2.50) Z=-1.906 0.057
    PCT(ng/mL) 0.42(0.20~1.04) 0.45(0.22~0.87) Z=-0.444 0.657
    注:ANC,中性粒细胞绝对值;PTA,凝血酶原活动度;PCT,降钙素原。
    下载: 导出CSV

    表  2  ACLF患者发生肺部感染的多因素分析

    Table  2.   Multivariate logistic regression analysis of influencing factors of pulmonary infection patients with ACLF

    因素 B Sb Wald χ2 P OR 95%CI
    上消化道出血 0.901 0.453 3.958 0.047 2.463 1.013~5.985
    其他部位感染 0.755 0.260 8.416 0.004 2.128 1.278~3.545
    股静脉置管 0.924 0.276 11.192 0.001 2.520 1.466~4.330
    联合使用≥2种抗生素 1.088 0.268 16.537 0.001 2.969 1.757~5.018
    常量 -1.869 0.237 62.017 0.154
    下载: 导出CSV
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