急诊监护病房动脉瘤性蛛网膜下腔出血患者下呼吸道感染危险因素及可视化预测模型

Risk factors and visual prediction model for lower respiratory tract infection in patients with aneurysmal subarachnoid hemorrhage in emergency care unit

    摘要
  • 摘要:
    目的 探讨急诊监护病房动脉瘤性蛛网膜下腔出血(aSAH)患者下呼吸道感染的危险因素，并建立动aSAH患者下呼吸道感染的列线图模型。
    方法 选取2020年2月-2023年7月南京医科大学第一附属医院收治的327例aSAH患者作为研究对象，根据aSAH患者下呼吸道感染情况分为下呼吸道感染组(n=79)和无下呼吸道感染组(n=248)。采用lasso分析筛选aSAH患者下呼吸道感染的预测因素。采用logistic回归筛选aSAH患者下呼吸道感染的危险因素。采用R(4.2.3)建立aSAH患者下呼吸道感染的列线图模型，并验证aSAH患者下呼吸道感染的列线图模型。
    结论 logistic回归分析的结果显示，责任动脉瘤位置(后循环)(OR=2.568)、Hunt-Hess分级(Ⅲ~Ⅳ级)(OR=3.576)、使用糖皮质激素(OR=2.983)、侵入性操作(OR=3.190)、肺部慢性疾病史(OR=3.214)、意识障碍(OR=2.631)及糖尿病(OR=2.419)是aSAH患者下呼吸道感染的危险因素(P < 0.05)。交互作用分析显示，糖尿病、使用糖皮质激素对aSAH患者下呼吸道感染的发生风险之间存在相加交互作用。aSAH患者下呼吸道感染的列线图模型的受试者工作特征(ROC)曲线下面积为0.756(95%CI：0.691~0.821)，校正曲线的预测值和实际值较接近；决策曲线显示阈值概率是6%~84%时，列线图对aSAH患者下呼吸道感染的预测具有良好的获益值。
    结论 基于责任动脉瘤位置在后循环、Hunt-Hess分级Ⅲ~Ⅳ级、使用糖皮质激素、侵入性操作、肺部慢性疾病史、意识障碍、糖尿病危险因素7项危险因素建立的列线图模型能有效预测aSAH患者下呼吸道感染的发生风险。

     

    Abstract:
    OBJECTIVE To explore the risk factors for lower respiratory tract infection (LRTI) in patients with aneurysmal subarachnoid hemorrhage (aSAH) in the emergency care unit and to establish a nomogram model for LRTI in patients with aSAH.
    METHODS A total of 327 patients with aSAH admitted to the First Affiliated Hospital with Nanjing Medical University from Feb. 2020 to Jul. 2023 were enrolled as study subjects. Based on the presence of LRTI in patients with aSAH, they were divided into an LRTI group (n=79) and a no-LRTI group (n=248). Lasso analysis was used to screen predictive factors for LRTI in patients with aSAH. Logistic regression was employed to identify risk factors for LRTI in patients with aSAH. The R software version 4.2.3 was utilized to develop and validate a nomogram model for LRTI in patients with aSAH.
    RESULTS Logistic regression analysis revealed that the location of the responsible aneurysm in the posterior circulation (OR=2.568), Hunt-Hess grading (grades Ⅲ-Ⅳ) (OR=3.576), use of glucocorticoids (OR=2.983), invasive procedures (OR=3.190), history of chronic lung diseases (OR=3.214), disturbance of consciousness (OR=2.631) and diabetes (OR=2.419) were risk factors for LRTI in patients with aSAH (P < 0.05). Interaction analysis showed an additive interaction existed between diabetes and the use of glucocorticoids on the risk of LRTI in patients with aSAH. The area under the receiver operating characteristic (ROC) curve of the nomogram model for LRTI in patients with aSAH was 0.756 (95% CI: 0.691-0.821), and the calibration curve demonstrated good agreement between predicted and actual values. Decision curve analysis indicated that the nomogram provided good net benefit for predicting LRTI in patients with aSAH when the threshold probability ranged from 6% to 84%.
    CONCLUSIONS The nomogram model established based on seven risk factors, including location of the responsible aneurysm in the posterior circulation, Hunt-Hess grades Ⅲ-Ⅳ, use of glucocorticoids, invasive procedures, history of chronic lung disease, disturbance of consciousness and diabetes, can effectively predict the risk of LRTI in patients with aSAH.

     

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