重症监护病房耐碳青霉烯类革兰阴性菌医院感染风险预测模型构建与验证
Construction and validation of a risk prediction model for hospital-associated infection caused by carbapenem-resistant gram-negative organism in intensive care unit
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摘要:目的 探讨和分析重症监护病房(ICU)患者发生耐碳青霉烯类革兰阴性菌(CRO)医院感染的危险因素,并建立与验证风险预测模型。方法 回顾性收集2024年1-6月北京大学第三医院成人ICU 338例革兰阴性菌医院感染患者作为建模组,2024年7-12月141例革兰阴性菌医院感染患者作为验证组,利用建模组数据建立Lasso logistic回归模型,根据β值对危险因素赋分,并建立风险预测模型,通过绘制ICU患者CRO医院感染风险预测的受试者工作特征(ROC)曲线对模型效能进行验证。结果 logistic回归分析显示,机械通气、急诊入院、急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)≥15分、C-反应蛋白≥10 mg/L、使用酶抑制剂复方制剂及使用碳青霉烯类药物是影响建模组ICU患者发生CRO医院感染的危险因素(P＜0.05),对应的风险预测模型中,分别被赋予2、1、1、1、1、2分。风险模型在建模组中的ROC曲线下面积(AUC)为0.895(95%CI：0.860~0.930,P＜0.001),特异度为81.02%,敏感度为83.84%,在验证组中AUC为0.764(95%CI：0.686~0.842,P＜0.001),特异度为59.13%,敏感度为77.30%。结论 本研究构建的风险评估体系对于包括建模组和验证组在内的所有ICU住院患者均有良好的预测效果,可提前发现潜在的高风险群体并及早干预。Abstract:OBJECTIVE To explore and analyze the risk factors for hospital-associated infection caused by carbapenem-resistant gram-negative organism (CRO) in patients in the intensive care unit (ICU)， and to establish and validate a risk prediction model.METHODS A retrospective collection was conducted on 338 patients with hospital-associated infection caused by gram-negative organism admitted to the adult ICU of Peking University Third Hospital from Jan. to Jun. 2024， serving as the modeling group. Additionally， 141 patients with hospital-associated infection caused by gram-negative organism admitted from Jul. to Dec. 2024 were included as the validation group. Based on the data from the modeling group， a lasso logistic regression model was established. Risk factors were assigned scores based on β values， and a risk prediction model was developed. The model′s performance was validated by plotting the receiver operating characteristic (ROC) curve for predicting CRO hospital-associated infection risk in ICU patients.RESULTS The logistic regression analysis indicated that mechanical ventilation， emergency admission， Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥15， C-reactive protein level ≥10mg/L， use of enzyme inhibitor compound preparations and use of carbapenems were risk factors for the development of CRO hospital-associated infection in patients in the ICU in the modeling group (P＜0.05). In the corresponding risk prediction model， these factors were assigned scores of 2， 1， 1， 1， 1 and 2， respectively. The area under the ROC curve (AUC) of the risk model in the modeling group was 0.895 (95%CI: 0.860-0.930， P＜0.001)， with a specificity of 81.02% and a sensitivity of 83.84%. In the validation group， the AUC was 0.764 (95%CI: 0.686-0.842， P＜0.001)， with a specificity of 59.13% and a sensitivity of 77.30%.CONCLUSIONS The risk assessment system constructed in this study demonstrates good predictive performance for all inpatients in the ICU， including those in the modeling group and validation group. It allows for the early identification of potential high-risk groups and facilitates timely intervention.
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