胃癌患者术后腹腔感染风险预测模型的构建及验证
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国家自然科学基金项目(82372887)


Construction and validation of a predictive model for postoperative intra-abdominal infection risk in gastric cancer patients
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    摘要:

    目的 分析胃癌患者术后腹腔感染的危险因素,构建列线图预测模型,并对其进行验证。方法 选取2021年4月—2024年3月苏州大学附属第一医院普外科收治的588例胃癌手术患者为研究对象,收集患者临床资料,按照3 ∶1 比例将其随机分为训练集和验证集,比较两组患者临床资料,根据患者术后是否发生腹腔感染分为感染组和非感染组,进行单因素和多因素分析,基于多因素分析结果构建列线图预测模型,并对模型进行验证。结果 588例患者中52例(8.84%)术后发生腹腔感染。52份腹腔积液标本检出病原菌65株,其中革兰阴性菌47株 (72.31%),革兰阳性菌15株(23.07%),真菌3株(4.62%)。多因素logistic回归分析显示,根治度(显微镜下残留)、联合器官切除、高血压、腹部手术史、手术时间均为胃癌患者术后腹腔感染的独立危险因素(均P<0.05)。根据多因素分析结果构建胃癌患者术后腹腔感染的列线图预测模型,受试者工作特征(ROC)曲线结果显示,训练集和验证集ROC曲线下面积(AUC)分别为0.764(95%CI:0.677~0.852)、0.712(95%CI:0.565~0.860),提示模型对胃癌患者术后腹腔感染的区分度良好;Hosmer-Lemeshow检验结果显示,χ2值为8.491,P值为0.387,提示该模型拟合优度良好。决策曲线(DCA)分析结果显示,在训练集(0.05~0.4)和验证集(0.1~1.0)风险阈值范围内,使用该模型对术后腹腔感染高风险患者进行干预,可能获得正向收益;临床影响曲线(CIC)分析结果显示,在训练集(0~0.4)和验证集(0~0.5)风险阈值范围内,模型预测的感染病例数高于实际感染病例数,表明模型具有较好的临床实用性。结论 基于胃癌术后腹腔感染独立危险因素构建列线图预测模型,可为临床早期评估胃癌术后腹腔感染提供量化、直观的参考。

    Abstract:

    Objective To analyze the risk factors for postoperative intra-abdominal infection in gastric cancer patients, as well as construct and validate a nomogram prediction model. Methods 588 gastric cancer surgery patients who admitted to the Department of General Surgery of the First Affiliated Hospital of Soochow University from April 2021 to March 2024 were selected as the study subjects. Clinical data of patients were collected and randomly divided into the training set and the validation set according to the ratio of 3 ∶1. Clinical data between two groups of patients were compared. Patients were divided into the infection group and non-infection group according to whether they had intra-abdominal infection after surgery. Univariate and multivariate analyses were conducted, and a nomogram prediction model was constructed and validated based on the results of multivariate analysis. Results Among the 588 patients, 52 (8.84%) had postoperative intra-abdominal infection. A total of 65 strains of pathogens were detected from 52 peritoneal fluid specimens, out of which 47 (72.31%) were Gram-negative bacteria, 15 (23.07%) were Gram-positive bacteria, and 3 (4.62%) were fungi. Multivariate logistic regression analysis showed that the degree of eradication (microscopic residue), combined organ resection, hypertension, history of abdominal surgery, and duration of surgery were all independent risk factors for postoperative intra-abdominal infection in gastric cancer patients (all P<0.05). Based on multivariate analysis results, a nomogram prediction model for postoperative intra-abdominal infection in gastric cancer patients was constructed. The receiver operating characteristic (ROC) curve result showed that the areas under the ROC curve (AUCs) of the training set and validation set were 0.764 (95%CI: 0.677-0.852) and 0.712 (95%CI: 0.565-0.860), respectively, indicating that the model had good discriminability for postoperative intra-abdominal infection in gastric cancer patients. Hosmer-Lemeshow test showed a χ2 value of 8.491 and a P value of 0.387, suggesting goodness fit of the model. The decision curve analysis (DCA) result showed that within the risk threshold ranges of the training set (0.05-0.4) and validation set (0.1-1.0), positive benefits may be obtained by using the model to intervene in patients with high risk of postoperative intra-abdominal infection. Clinical impact curve (CIC) analysis result showed that within the risk threshold ranges of the training set (0-0.4) and validation set (0-0.5), the number of infected cases predicted by the model was higher than the actual number, indicating good clinical practicality of the model. Conclusion Construction of a nomogram prediction model based on independent risk factors for postoperative intra-abdominal infection in gastric cancer can provide a quantitative and intuitive reference for the early clinical assessment of postoperative intra-abdominal infection in gastric cancer.

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侯昱,顾启红,周进,等.胃癌患者术后腹腔感染风险预测模型的构建及验证[J]. 中国感染控制杂志,2025,24(6):753-761. DOI:10.12138/j. issn.1671-9638.20257069.
HOU Yu, GU Qihong, ZHOU Jin, et al. Construction and validation of a predictive model for postoperative intra-abdominal infection risk in gastric cancer patients[J]. Chin J Infect Control, 2025,24(6):753-761. DOI:10.12138/j. issn.1671-9638.20257069.

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  • 收稿日期:2024-10-16
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  • 在线发布日期: 2025-06-24
  • 出版日期: 2025-06-28