个体化预测老年心脏瓣膜置换术后医院感染风险Nomogram模型的构建

doi:10.6040/j.issn.1671-7554.0.2023.0965

摘要/Abstract

摘要： 目的构建个体化预测老年心脏瓣膜置换术后医院感染风险Nomogram模型,为早期筛查老年瓣膜置换术后医院感染的高风险人群及制定针对性预防策略提供依据。方法回顾性收集2020年1月1日至2021年12月31日山东大学齐鲁医院行心脏瓣膜置换手术的334例老年患者临床相关资料,其中男176例,女158例,60~81岁,平均(65.86±4.34)岁。采用Lasso回归及多因素Logistic回归筛选老年心脏瓣膜置换术后医院感染的独立危险因素,依据独立危险因素构建个体化预测老年心脏瓣膜置换术后医院感染风险Nomogram模型,采用Bootstrap自抽样法(n=1 000)进行模型的内部验证,采用C-指数或受试者工作特征(receiver operating characteristic, ROC)曲线下面积、校准曲线、决策曲线检测模型的预测性能。结果 334例老年心脏瓣膜置换手术患者,发生医院感染91例,发生率27.25%。心力衰竭、应激性高血糖、留置胃管、肺动脉高压、左心室射血分数(left ventricular ejection fraction, LVEF)、美国麻醉医师协会评分(American Society of Anesthesiologists, ASA)是老年心脏瓣膜置换术后医院感染的独立危险因素,依据上述变量构建风险Nomogram模型,经内部验证发现,模型校正后的C-指数为0.80;校准曲线显示模型预测老年心脏瓣膜置换术后医院感染的发生风险与实际医院感染的发生风险之间的一致性较好;临床决策曲线显示模型净获益较好。结论构建的个体化预测老年心脏瓣膜置换术后医院感染风险Nomogram模型具有较好的区分度、校准度和临床有效性,有助于提高对老年心脏瓣膜置换术后医院感染的高风险人群的早期筛查,尽早制定针对性干预策略,以降低医院感染发生率。

关键词: 心脏瓣膜置换, 医院感染, 危险因素, Nomogram

Abstract: Objective To develop a nomogram model for individualized prediction of the risk of nosocomial infection after heart valve replacement in the elderly patients, so as to provide a basis for the early screening of the high-risk population and the formulating of targeted prevention strategies. Methods The clinical data of 334 elderly patients who underwent heart valve replacement surgery in Qilu Hospital of Shandong University during Jan. 1, 2020 and Dec. 31, 2021 were retrospectively collected, including 176 males and 158 females, aged 60-81 years, with an average of(65.86±4.34)years. The independent risk factors for nosocomial infection were identified with Lasso regression and multivariate Logistic regression, based on which, a nomogram model for individualized prediction of risk was constructed. The internal validation of the model was tested with Bootstrap self-sampling method(n=1,000). The predictive performance of the model was tested with C-index, area under the receiver operating characteristic(ROC)curve, calibration curve or decision curve. Results A total of 91 nosocomial infection occurred, with an incidence of 27.25%. Heart failure, stress hyperglycemia, indignant gastric tube, pulmonary hypertension, left ventricular ejection fraction(LVEF)and American Society of Anesthesiologists(ASA)were independent risk factors for nosocomial infection. Based on the above variables, a nomogram model was constructed, whose C-index after correction was 0.80. The calibration curve showed that the model could accurately predict the risk of nosocomial infection. The clinical decision curve showed good net benefit. Conclusion The nomogram model for the prediction of nosocomial infection risk in the elderly patients after heart valve replacement has good differentiation, calibration and clinical effectiveness, which can help to screen the high-risk group and formulate targeted intervention strategies, so as to reduce the incidence of nosocomial infection.

Key words: Heart valve replacement, Nosocomial infection, Risk factor, Nomogram

中图分类号:

R654.2

宋甜田,李作坤,王书会. 个体化预测老年心脏瓣膜置换术后医院感染风险Nomogram模型的构建[J]. 山东大学学报 (医学版), 2024, 62(1): 48-56.

SONG Tiantian, LI Zuokun, WANG Shuhui. Development of a nomogram model for individualized prediction of the risk of nosocomial infection after heart valve replacement in elderly patients[J]. Journal of Shandong University (Health Sciences), 2024, 62(1): 48-56.

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