摘要
目的探讨永久性心脏起搏器植入患者术后囊袋感染的风险因素,依此构建个性化的风险预测模型。方法采用回顾性队列研究方法分析2016年1月—2018年5月安徽省某三级甲等医院心血管内科收治的且接受永久性心脏起搏器植入术患者的临床资料及随访资料。依据患者术后1年囊袋感染的发生情况将受试对象分为感染组和未感染组。采用lasso回归和logistic回归分析永久性心脏起搏器植入术患者术后囊袋感染的独立风险因素。结果共纳入322例永久性心脏起搏器植入术患者,术后起搏器囊袋感染的发病率为7.45%(24例)。lasso回归和多因素logistic回归模型分析结果显示,年龄、手术时长、手术次数、切口愈合不良是受试对象术后囊袋感染发生的独立风险因素(均P<0.05)。构建的列线图模型通过Bootstrp自抽样1000次进行内部验证,内部验证后列线图模型的C统计量为0.869(95%CI:0.773~0.947),提示列线图具有较好的区分度。校准曲线分析表明列线图模型的预测概率与患者实际发生情况的平均绝对误差为0.018,提示列线图具有较好的校准度。决策曲线分析法表明,当列线图模型的概率阈值为0.03~0.62时,患者的临床净收益率最高,提示列线图模型具有较好的临床适用性。结论永久性心脏起搏器植入患者术后囊袋感染的发生情况受多种风险因素影响,列线图可整合术后囊袋感染的风险因素并用于个性化地预测患者术后囊袋感染风险,具有较高的临床应用价值。
Objective To explore the risk factors for pocket infection in patients with permanent pacemaker implantation(PPI),and construct a personalized risk prediction model.Methods Retrospective cohort study method was adopted to analyze clinical data and follow-up data of patients who received PPI in the department of cardiovascular diseases of a tertiary first-class hospital in Anhui Province from January 2016 to May 2018.According to the occurrence of pocket infection one year after operation,patients were divided into infection group and non-infection group.Independent risk factors for post-operative pocket infection in patients with PPI were analyzed with lasso regression and logistic regression analysis.Results A total of 322 patients with PPI were included in analysis,incidence of post-operative pocket infection was 7.45%(n=24).Lasso regression and multivariate logistic regression model analysis results showed that age,duration of operation,operation times and poor wound healing were independent risk factors for post-operative pocket infection(all P<0.05).The constructed nomogram model was internally verified by Bootstrp self-sampling for 1000 times,after internal verification,C-statistic of nomogram model was 0.869(95%CI:0.773-0.947),suggesting that the nomogram has good discrimination.Calibration curve analysis showed that the average absolute error between prediction probability of nomogram model and the actual occurrence of PPI in patients was 0.018,which indicated that nomogram has a good calibration degree.Decision curve analysis(DCA)showed that when probability threshold of nomogram model was 0.03-0.62,clinical net benefit rate of patients was the highest,which indicated that nomogram model had better clinical applicability.Conclusion The occurrence of post-operative pocket infection in patients with PPI is affected by multiple risk factors,nomogram can integrate the risk factors for post-operative pocket infection and be used to personalized prediction of risk of post-operative pocket infection in patients
作者
周晓娟
马礼坤
张理想
詹玲
ZHOU Xiao-juan;MA Li-kun;ZHANG Li-xiang;ZHAN Ling(Department of Cardiovascular Diseases,First Affiliated Hospital of University of Science and Technology of China,Hefei 230036,China)
出处
《中国感染控制杂志》
CAS
CSCD
北大核心
2021年第10期881-888,共8页
Chinese Journal of Infection Control
基金
国家自然科学基金面上项目(81870192)。
关键词
永久性心脏起搏器植入术
囊袋感染
风险因素
列线图
permanent pacemaker implantation
pacemaker pocket infection
risk factor
nomogram
