基于倾向性评分匹配与广义线性模型的ICU患者医院获得耐碳青霉烯鲍曼不动杆菌感染的经济负担评价

Economic burden evaluation of hospital-acquired carbapenem-resistant Acinetobacter baumannii infection in intensive care unit patientsbased on propensity score matching and generalized linear models

    摘要
  • 摘要:
    目的 应用倾向性评分匹配（PSM）和广义线性模型（GLM）评估重症监护室（ICU）患者医院获得耐碳青霉烯鲍曼不动杆菌（CRAB）感染导致的直接经济负担，以期为DRG付费改革背景下的医院成本控制与感染防控策略优化提供循证依据。
    方法 选取2019年1月－2024年12月自贡市第一人民医院和富顺县人民医院ICU的7 564例住院患者为研究对象，依据院内检出CRAB分为CRAB检出组（221例）和对照组（7343例）。采用倾向性评分匹配（PSM）对两组进行1∶1匹配，比较匹配后两组的住院日数与各项住院费用。建立广义线性模型再次计算匹配后患者的总住院日数、ICU住院日数和住院费用的比值比（OR值）。
    结果 ICU患者CRAB检出率为2.92%（221/7 564），采用PSM成功匹配220对，PSM分析显示，CRAB检出组中位住院日数较对照组长13.00 d（P＜0.001）、住院费用增加565 97.51元，增加106.31%（P＜0.001）。GLM结果显示，CRAB检出组相较于对照组住院日数、ICU住院日数和住院费用OR值分别为：2.020（95%CI：1.759～2.316）、2.255（95%CI：1.956～2.596）和2.108（95%CI：1.936～2.298）。2019－2024年两家医院因ICU医院获得CRAB产生的直接损失为51.12万元。
    结论 本研究通过PSM和GLM有效控制混杂偏倚，证实ICU内医院获得CRAB会显著延长患者的住院时间，并造成沉重的直接经济负担。

     

    Abstract:
    OBJECTIVE  To evaluate the direct economic burden of Carbapenem-resistant Acinetobacter baumannii （CRAB） infection in intensive care unit （ICU） patients through propensity score matching （PSM） and Generalized Linear Models （GLM）, thereby providing evidence for optimizing hospital cost control and infection prevention strategies within the context of Diagnosis-Related Group （DRG） payment reform.
    METHODS  A total of 7 564 inpatients were enrolled from the ICU of Zigong First People's Hospital and Fushun People's Hospital between Jan. 2019 and Dec. 2024. They were divided into a CRAB-positive group （n=221） and a control group （n=7 343） based on the CRAB detection during hospitalization. PSM was adopted to perform 1:1 matching between the two groups, and the length of hospital stay and various hospitalization costs were compared between the groups. A generalized linear model was established to recalculate the Odds Ratios （OR） for total hospital days, ICU days and hospitalization costs in the matched cohorts.
    RESULTS  The detection rate of CRAB in ICU patients was 2.92% （221/7 564）. PSM successfully matched 220 pairs.Analysis of the matched cohorts showed that the CRAB-positive group had a significantly longer median hospital stay （by 13.00 days, P＜0.001） and higher median hospitalization costs （by RMB 56 597.51, a 106.31% increase, P＜0.001） compared to the control group.The results of the GLM showed that the OR values of hospitalization days, ICU hospitalization days and hospitalization expenses in the CRAB-positive group compared to the control group were 2.020 （95%CI: 1.759−2.316）, 2.255 （95%CI: 1.956−2.596） and 2.108 （95%CI: 1.936−2.298）, respectively. The direct losses incurred by two hospitals due to hospital-acquired CRAB in the ICU from 2019 to 2024 amounted to RMB 511 200.
    CONCLUSIONS  By effectively controlling for confounding bias with PSM and GLM, this study confirms that hospital-acquired CRAB infection in the ICU significantly prolongs patient hospitalization and imposes a substantial direct economic burden.

     

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