PICC早产儿导管相关血流感染预测模型的构建与验证

Construction and validation of prediction model for catheter-related bloodstream infection in preterm infants receiving PICC

摘要:

目的 构建早产儿经外周静脉置入中心静脉导管(PICC)相关血流感染(CRBSI)发生风险的预测模型,并对模型进行效果评价。方法 选取2019年1月—2023年10月入住某院新生儿重症监护病房(NICU)行PICC进行静脉输注的1 295例早产儿为研究对象,其中2019年1月—2022年12月1 080例早产儿为建模集,2023年1—10月215例早产儿为验证集,使用24项临床特征分析病例危险因素,采用LASSO回归进行优化特征选择,通过多因素logistic回归分析确定早产儿PICC留置期间发生CRBSI的独立危险因素,应用R软件制作列线图模型。使用受试者工作特征(ROC)曲线下面积(AUC)、Hosmer-Lemeshow检验及校准曲线评估模型的区分度和拟合度,使用决策曲线(DCA)评估该模型的临床实用性。结果 多因素logistic分析结果显示,出生体重≥1 500 g、导管维护时无菌防护、无菌巾包裹接头为早产儿PICC留置期间发生CRBSI的保护性因素(OR值分别为0.172、0.187、0.063,均P<0.05),穿刺次数＞2次、导管留置时间＞14 d、使用三通为早产儿PICC留置期间发生CRBSI的独立危险因素(OR值分别为2.533、14.128、13.256,均P<0.05)。建模集ROC曲线AUC为0.953(95%CI:0.936~0.969),验证集ROC曲线的AUC为0.930(95%CI:0.885~0.974),表明该模型区分度良好。校正曲线和Hosmer-Lemeshow拟合优度检验显示该模型准确性和一致性较好,净收益值高,表明预测模型的预测价值高,有较好的临床实用性,且模型的合理性分析中统计学检验结果P＜0.001。结论 研究基于早产儿一般临床特征以及导管基础防控措施构建的列线图模型能够为临床医务人员早期识别PICC相关CRBSI高危因素提供可视化、简单的评估工具。

Abstract:

Objective To construct a prediction model for the risk of peripherally inserted central venous catheter (PICC)-related bloodstream infection (CRBSI) in preterm infants, and evaluate the effect of the model. Methods 1 295 preterm infants admitted to the neonatal intensive care unit (NICU) in a hospital and received PICC intravenous infusion from January 2019 to October 2023 were selected as the study subjects, including 1 080 preterm infants from January 2019 to December 2022 in the modeling set and 215 premature infants from January to October 2023 in the validation set.Risk factors of cases were analyzed based on 24 clinical characteristics, optimized characteristics was selected by LASSO regression, independent risk factors for CRBSI of preterm infants during PICC indwelling period were identified by multiple logistic regression analysis, and nomogram model was constructed with R software. Discrimination and fitting of the model were evaluated by the area under the curve (AUC) of the receiver operating characteristic (ROC) as well as Hosmer-Lemeshow test and calibration curve, and clinical practicality of the model was evaluated by decision curve analysis (DCA). Results Multivariate logistic analysis showed that birth weight ≥1 500 g, sterile protection during catheter maintenance, and sterile cloth wrapped joints were protective factors for CRBSI during PICC indwelling period in preterm infants (OR=0.172, 0.187, 0.063, respectively, all P<0.05), while puncture frequency ＞2 times, catheter indwelling period ＞14 days, and use of tees were independent risk factors for CRBSI during PICC indwelling period in premature infants (OR=2.533, 14.128, 13.256, respectively, all P<0.05). The AUC of ROC of the modeling set was 0.953 (95%CI: 0.936-0.969), and that of the validation set was 0.930 (95%CI: 0.885-0.974), indicating good discriminability of the model. The calibration curve and Hosmer-Lemeshow goodness of fit test showed that the model had good accuracy and consistency, with high net profit value, indicating that the predictive value of the model was high and with good clinical practica-lity. The statistical test result in the rationality analysis of the model was P<0.001. Conclusion The nomogram model based on the general clinical characteristics of preterm infants as well as the basic prevention and control measures of the catheter can provide a visual and simple evaluation tool for early identification of high risk factors for CRBSI in preterm infants.