肝癌患者经肝动脉化疗栓塞术后感染风险预测模型的构建及验证
作者:
作者单位:

1.南方医科大学南方医院医院感染管理科, 广东 广州 510515;2.南方医科大学护理学院, 广东 广州 510515

作者简介:

通讯作者:

翟惠敏  E-mail: hlrwxjyssmu@126.com

中图分类号:

+2 R735.7]]>

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Construction and validation of a risk prediction model for the infection after transcatheter arterial chemoembolization in patients with liver cancer
Author:
Affiliation:

1.Department of Healthcare-associated Infection Management, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China;2.School of Nursing, Southern Medical University, Guangzhou 510515, China

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    摘要:

    目的 构建并验证肝癌患者经肝动脉化疗栓塞术(TACE)后感染风险预测模型。 方法 回顾性收集2016年1月—2018年3月某院1 043例肝癌行TACE手术患者的临床资料, 根据TACE后是否发生感染分为感染组及未感染组, 采用logistic回归分析筛选肝癌患者TACE后感染的危险因素并构建列线图模型, 采用Bootstrap法对模型进行内部验证。收集2020年1—7月该院349例肝癌行TACE患者作为验证集对模型进行外部验证, 采用C-统计量、校准曲线评价模型的预测性能。 结果 1 043例肝癌患者接受TACE后感染105例, 感染发生率为10.07%。胆道介入手术史、最大肿瘤直径>5 cm、腹腔积液、肝癌破裂出血、碘化油剂量>12 mL及加用补充栓塞材料是TACE后感染的独立危险因素(均P<0.05), 既往TACE史为TACE后感染的保护因素(P<0.05)。肝癌患者TACE后感染风险预测模型为Logit (P)=-4.403+1.874×胆道介入手术史-1.101×既往TACE史+1.253×最大肿瘤直径>5 cm+1.163×腹腔积液+1.346×肝癌破裂出血+0.901×碘化油剂量>12 mL+1.369×加用补充栓塞材料。该模型C-统计量为0.857, 95%CI为0.822~0.892, 约登指数最大值为0.596, 临界值为0.109, 灵敏度为84.8%, 特异度为74.8%。内、外部验证C-统计量分别为0.847、0.829, 校准曲线和Brier得分均显示模型拟合良好。 结论 研究构建的肝癌患者TACE后感染风险预测模型的区分度及校准度良好, 可作为临床上肝癌患者TACE后感染的预测工具。

    Abstract:

    Objective To construct and validate the risk prediction model of infection in patients with liver cancer after transcatheter arterial chioibolization (TACE). Methods Clinical data of 1043 liver cancer patients underwent TACE in a hospital from January 2016 to March 2018 were collected retrospectively. According to whether infection occured after TACE, patients were divided into infected group and non-infected group. Risk factors for the infection after TACE were screened by logistic regression analysis, and nomograph model was constructed and internally verified by Bootstrap method. 349 liver cancer patients underwent TACE from January to July 2020 in this hospital were collected as the validation set for external validation of the model. C-statistics and calibration curves were used to evaluate the prediction performance of the model. Results Among 1043 liver cancer patients, 105 were infected after TACE, thus infection incidence was 10.07%. History of biliary tract interventional surgery, largest tumor diameter >5 cm, ascites, tumor rupture hiorrhage, dosage of lipiodol >12 mL and the use of additional ibolic materials were independent risk factors for the infection after TACE (all P < 0.05). Previous TACE history was the protective factor for the infection after TACE (P < 0.05).The risk prediction model for the infection after TACE in liver cancer patients were Logit(P)=-4.403+1.874×(history of biliary tract interventional surgery) -1.101×(history of previous TACE surgery) +1.253×(largest tumor diameter >5 cm) +1.163×(ascites) +1.346×(tumor rupture hiorrhage) +0.901×(dosage of lipiodol >12 mL) +1.369×(use of additional ibolic materials). C-statistic of the model was 0.857 (95% confidence interval [CI]: 0.822-0.892). The maximal index of Youden, critical value, sensitivity and specificity were 0.596, 0.109, 84.8%, and 74.8% respectively. C-statistics of internal and external validation were 0.847 and 0.829 respectively. Calibration curve and Brier score showed that the model fit well. Conclusion The prediction model of infection risk of liver cancer patients after TACE constructed in this study has good discrimination and calibration, thus can be used to predict the infection of liver cancer patients after TACE.

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引用本文

李海兰,翟惠敏,杨慧杰,等.肝癌患者经肝动脉化疗栓塞术后感染风险预测模型的构建及验证[J]. 中国感染控制杂志,2023,(2):150-158. DOI:10.12138/j. issn.1671-9638.20233028.
Hai-lan LI, Hui-min ZHAI, Hui-jie YANG, et al. Construction and validation of a risk prediction model for the infection after transcatheter arterial chemoembolization in patients with liver cancer[J]. Chin J Infect Control, 2023,(2):150-158. DOI:10.12138/j. issn.1671-9638.20233028.

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  • 收稿日期:2022-06-15
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  • 在线发布日期: 2024-04-28
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