摘要
目的探讨老年急性脑梗死(ACI)并发尿路感染(UTI)的logistic危险因素,构建并验证老年ACI患者并发UTI的风险预测模型。方法选取2020年3月-2021年3月保定市第一医院收治的120例老年ACI患者作为建模组,根据是否并发UTI分为感染组26例和未感染组94例。另选取同期本院和外院收治的60例老年ACI患者,分别作为内部验证组和外部验证组。留取中段尿标本行病原菌分离鉴定。比较两组白细胞计数(WBC)、中性粒细胞比例(NEUT%)和血清超敏C-反应蛋白(hs-CRP)、D-二聚体(D-D)、同型半胱氨酸(Hcy)水平;分析老年ACI患者并发UTI与临床特征的关系;Logistic回归分析影响老年ACI患者并发UTI的因素,并建立风险预测模型,HosmerLemeshow检验评估模型拟合度,使用受试者工作特征(ROC)曲线检测该模型的内部和外部验证的诊断效能。结果老年ACI患者并发UTI感染率为21.67%,分离菌株以大肠埃希菌(27.27%)和肺炎克雷伯菌(12.12%)为主。感染组WBC[(9.73±1.41)×10^(9)/L vs.(7.26±1.38)×10^(9)/L]、NEUT%[(73.28±9.76)%vs.(63.54±7.34)%]、hs-CRP[(27.94±5.18)ng/L vs.(21.38±3.66)ng/L]、D-D[(3.65±0.94)mg/L vs.(2.59±0.23)mg/L]和Hcy[(24.16±3.72)μmol/L vs.(20.47±2.56)μmol/L]水平均显著高于未感染组,差异均有统计学意义(t=8.040、5.554、7.346、9.998、5.582,P均<0.05)。老年ACI患者并发UTI与年龄、合并糖尿病、尿路感染史、尿路手术史、意识障碍、留置导尿管时间和住院时间有关(P均<0.05)。Logistic回归分析显示,合并糖尿病、尿路感染史、长期留置导尿管和NEUT、Hcy水平升高均为影响老年ACI患者并发UTI的独立危险因素(P均<0.05);建立logistic回归风险预测模型,预测概率P=1/[1+e^(-2.705+0.905×(合并糖尿病)+1.032×(尿路感染史)+0.781×(留置导尿管时间)+0.996×(NEUT)+0.708×(Hcy))],内部验证的AUC为0.859,外部验证的AUC为0.785(P<0.05);Hosmer-Lemeshow拟合优度检验显示,Hosmer-Lemeshowχ^(2)=7.692,P=0.089。结论合并糖尿病、尿路感染史、长期留置导尿管和NEUT、Hcy水平升高均为影响老年ACI患者并发UTI的独立危险因素。Logistic风险预测模型的诊断效能在内部验证和外部验证中表现良好,对老年ACI患者并发UTI的预测价值高。
Objective To explore logistic risk factors of urinary tract infection(UTI)in elderly patients with acute cerebral infarction(ACI),and construct and verify the risk prediction model for UTI.Methods A total of 120 elderly patients with ACI admitted to the Baoding First Hospital were enrolled as modeling group between March 2020 and March 2021.According to presence or absence of UTI,they were divided into infection group(26 cases)and non-infection group(94 cases).A total of 60 elderly patients with ACI admitted to the hospital and 60 elderly patients with ACI admitted to the other hospital were enrolled as internal verification group and external verification group between March 2020 and March 2021,respectively.The specimens of midstream urine were collected for isolation and identification of pathogens.The levels of white blood cell count(WBC),neutrophil ratio(NEUT%),serum high-sensitivity C-reactive protein(hs-CRP),d-dimer(D-D)and homocysteine(Hcy)were compared between the two groups.The relationship between UTI and clinical characteristics was analyzed.The influencing factors of UTI were analyzed by logistic regression analysis.The risk prediction model was constructed,the fit of model was evaluated by Hosmer-Lemeshow test,and its diagnostic efficiency of internal verification and external verification was detected by receiver operating characteristic(ROC)curves.Results The incidence of UTI in elderly patients with ACI was 21.67%.The main pathogens were Escherichia coli(27.27%)and Klebsiella pneumoniae(12.12%).The levels of WBC[(9.73±1.41)×10^(9)/L vs.(7.26±1.38)×10^(9)/L],NEUT%[(73.28±9.76)%vs.(63.54±7.34)%],hs-CRP[(27.94±5.18)ng/L vs.(21.38±3.66)ng/L],D-D[(3.65±0.94)mg/L vs.(2.59±0.23)mg/L]and Hcy[(24.16±3.72)μmol/L vs.(20.47±2.56)μmol/L]in infection group were significantly higher than those in non-infection group(t=8.040,5.554,7.346,9.998,5.582,all P<0.05).The occurrence of UTI was related to age,diabetes mellitus,UTI history,history of urinary tract surgery,disturbance of consciousness,catheter indwelling time and hospitalization time(P<0.05).Logistic regression analysis showed that diabetes mellitus,UTI history,long-term catheter indwelling,increased NEUT and Hcy were independent risk factors of UTI in elderly patients with ACI(P<0.05).The probability of UTI by logistic risk prediction model was as follow:P=1/[1+e^(-2.705+0.905×(diabetes mellitus)+1.032×(UTI history)+0.781×(catheter indwelling time)+0.996×(NEUT)+0.708×(Hcy))];AUC values of internal verification and external verification for predicting UTI were 0.859 and 0.785,respectively(P<0.05).The results of Hosmer-Lemeshow goodness of fit test were as follows:Hosmer-Lemeshowχ^(2)=7.692,P=0.089.Conclusions Diabetes mellitus,UTI history,long-term catheter indwelling,increased NEUT and Hcy were independent risk factors of UTI in elderly patients with ACI.Logistic risk prediction model had good diagnostic efficiency in internal verification and external verification,which has high predictive value for UTI.
作者
张媛媛
邸丹丹
师逸墨
王会军
陈艳霜
ZHANG Yuanyuan;DI Dandan;SHI Yimo;WANG Huijun;CHEN Yanshuang(Department of Neurology,Baoding First Hospital,Baoding,Hebei 071000,China;Color Ultrasonic Room,Baoding First Hospital,Baoding,Hebei 071000,China)
出处
《热带医学杂志》
CAS
2023年第10期1432-1437,共6页
Journal of Tropical Medicine
基金
保定市科技计划项目(2141ZF051)
关键词
老年
急性脑梗死
尿路感染
中性粒细胞比例
同型半胱氨酸
Elderly
Acute cerebral infarction
Urinary tract infection
Neutrophil ratio
Homocysteine
