摘要
目的 探讨老年慢性肾衰竭维持性血液透析(MHD)患者医院感染影响因素及风险预测模型的构建。方法 选取2018年1月-2020年12月中国医科大学附属第一医院收治的老年慢性肾衰竭MHD患者149例,其中45例发生医院感染患者为感染组,其余104例为非感染组,分析感染病原菌分布,多因素Logistic回归模型分析老年慢性肾衰竭MHD患者医院感染的影响因素并构建风险预测模型,使用受试者工作特征曲线(ROC)分析风险预测模型的区分度、Hosmer-Lemeshow评估风险预测模型的拟合度。结果 45例老年慢性肾衰竭MHD医院感染患者共分离病原菌59株,主要以革兰阴性菌为主;多因素Logistic回归分析结果显示,糖尿病、透析时间≥1年、血清白蛋白<35 g/L、血红蛋白<90 g/L是老年慢性肾衰竭MHD患者医院感染的独立影响因素(P<0.05);老年慢性肾衰竭MHD医院感染风险预测模型的Hosmer-Lemeshow检验该风险预测模型的拟合优度良好(P=0.416),ROC曲线下面积(AUC)为0.839(95%CI:0.773~0.905),敏感度为75.50%,特异度为77.90%。结论 老年慢性肾衰竭MHD医院感染感染病原菌主要以革兰阴性菌为主,合并糖尿病、透析时间、低蛋白血症和贫血会增加老年慢性肾衰竭MHD患者医院感染风险,基于此构建的风险预测模型的区分度、拟合度良好。
OBJECTIVE To explore the influencing factors for nosocomial infection in elderly patients with chronic renal failure undergoing maintenance hemodialysis(MHD) and the establishment of risk prediction model.METHODS A total of 149 elderly patients with chronic renal failure who underwent MHD in The First Hospital Affiliated to China Medical University from Jan 2018 to Dec 2020 were enrolled in the study,45 of whom had nosocomial infection and were assigned as the infection group,and 104 did not have nosocomial infection and were assigned as the no infection group.The pathogens causing infection were observed,multivariate logistic regression analysis was performed for influencing factors for nosocomial infection in the elderly patients with chronic renal failure undergoing MHD,the risk prediction model was established,the discrimination degree of the risk prediction model was analyzed by receiver operating characteristic(ROC) curve,and the fitting degree was evaluated by Hosmer-Lemeshow.RESULTS Totally 59 strains of pathogens were isolated from 45 elderly renal failure patients with nosocomial infection,and gram-negative bacteria were dominant.The result of multivariate logistic regression analysis showed that diabetes mellitus,length of dialysis time no less than 1 year,serum albumin less than 35 g/L and hemoglobin less than 90 g/L were independent influencing factors for nosocomial infection in the elderly renal failure patients undergoing MHD(P<0.05).Hosmer-Lemeshow test showed that the fitting degree of the risk prediction model was good(P=0.416),the areas under ROC curve(AUC) was 0.839(95%CI:0.773~0.905),with the sensitivity 75.50%,the specificity 77.90%.CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the elderly renal failure patients with nosocomial infection.Complication with diabetes mellitus,length of dialysis time,hypoproteinemia and anemia may increase the risk of nosocomial infection in the elderly patients undergoing MHD,and the discrimination degree and fitting degr
作者
李晓丹
李金鑫
解吉雄
王锐
吕冰
戴颖
LI Xiao-dan;LI Jin-xin;XIE Ji-xiong;WANG Rui;LYU Bing;DAI Ying(The First Hospital Affiliated to China Medical University,Shenyang,Liaoning 110001,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2022年第18期2785-2788,共4页
Chinese Journal of Nosocomiology
基金
辽宁省自然科学计划项目(202012113733)。
关键词
慢性肾衰竭
维持性血液透析
医院感染
病原菌
影响因素
风险预测模型
Chronic renal failure
Maintenance hemodialysis
Nosocomial infection
Pathogen
Influencing factor
Risk prediction model
