摘要
目的通过建立泌尿系统术后留置双J管患者尿路感染(UTI)临床预测模型,提高临床对于此类患者的诊治能力。方法选择2018年1月~2022年7月本院泌尿外科接受手术留置双J管患者为研究对象,经病历筛选最终入组研究对象共137例,将尿路感染患者纳入UTI组,未发生尿路感染者纳入非UTI组。对性别、年龄、体质量指数(BMI)、双J管留置时间、合并糖尿病、尿路感染史、术前营养控制状态评分(COUNT)、手术时间、双J管侧别、合并肾功能不全情况进行统计,采用R-studio 4.0.2软件的“RMS”函数包完成多因素Logistic回归模型建立、列线图绘制,模型及单因素对双J管感染的诊断价值分析采用受试者工作特征曲线(ROC)进行评价。结果UTI组与非UTI组性别、年龄、BMI、合并糖尿病、手术时间、双J管侧别、合并肾功能情况比较差异无统计学意义(P>0.05),UTI组双J管留置时间、术前COUNT评分、尿路感染史比例均高于非UTI组(P<0.05);多因素Logistic回归分析结果发现双J管留置时间、尿路感染史、术前COUNT评分均为泌尿系统术后留置双J管相关尿路感染的独立影响因素(P<0.05),Bootstrap法对预测模型列线图进行内部验证,Hosmer-Lemeshow检验结果显示χ2=6.753,P=0.325,说明模型具有良好的校准度;ROC分析结果显示,双J管留置时间、尿路感染史、术前COUNT评分预测术后尿路感染的曲线下面积(AUC)分别为0.793、0.747、0.750,3个单因素联合建立的预测模型预测术后尿路感染的AUC为0.925,均具有良好的预测效能(P<0.05)。结论基于双J管留置时间、尿路感染史、术前COUNT评分所建立的预测模型对泌尿系统术后留置双J管患者尿路感染的发生概率有较好的预测能力,可在早期识别尿路感染高风险人群。
Objective To establish a clinical prediction model of urinary tract infection(UTI)in patients with indwelling double J stents after urological surgery to improve the diagnosis and treatment of such patients.Methods A total of 137 patients who underwent urological surgery and indwelling double J stents in our hospital from January 2018 to July 2022 were selected as the research subjects.After medical record screening,a total of 137 subjects were included in the study,and patients with UTI were included in the UTI group,and those without UTI were included in the non-UTI group.The gender,age,body mass index(BMI),indwelling time of double J stents,diabetes mellitus,history of urinary tract infection,preoperative nutritional status score(COUNT),operation time,side of double J stents,and combined renal dysfunction were collected.The multi-factor Logistic regression model was established using the"RMS"function package of R-studio 4.0.2 software,and the line chart was plotted.The diagnostic value of the model and single factors for double J stent infection was evaluated using the receiver operating characteristic curve(ROC).Results There were no significant differences in gender,age,BMI,diabetes mellitus,operation time,side of double J stents,and combined renal dysfunction between the UTI group and the non-UTI group(P>0.05).The indwelling time of double J stents,preoperative COUNT score,and proportion of urinary tract infection history in the UTI group were higher than those in the non-UTI group(P<0.05).Multivariate Logistic regression analysis showed that the indwelling time of double J stents,urinary tract infection history,and preoperative COUNT score were independent risk factors for postoperative urinary tract infection after urological surgery with indwelling double J stents(P<0.05).The internal validation of the prediction model line chart was performed using the Bootstrap method.The Hosmer-Lemeshow test showed thatχ2=6.753 and P=0.325,indicating that the model had good calibration.ROC analysis showed that the AUCs of double J stent indwelling time,urinary tract infection history,and preoperative COUNT score for predicting postoperative UTI were 0.793,0.747,and 0.750,respectively.The AUC of the prediction model established by these three individual factors for predicting postoperative UTI was 0.925,indicating good predictive accuracy(P<0.05).Conclusion The prediction model based on double J stent indwelling time,urinary tract infection history,and preoperative COUNT score has good predictive ability for the occurrence probability of urinary tract infection in patients with indwelling double J stents after urological surgery,which can be used to identify high-risk groups of urinary tract infection in the early stage.
作者
吴利兵
曹勇
庒华
厉波
李超群
Wu Libing;Cao Yong;Zhuang Hua(Department of Urology,Rizhao Central Hospital,Rizhao 276800,China)
出处
《华北理工大学学报（医学版）》
2024年第2期111-116,共6页
Journal of North China University of Science and Technology：Health Sciences Edition
关键词
泌尿系统手术
双J管
尿路感染
预测模型
列线图
Urological surgery
Double J stent
Urinary tract infection
Prediction model
Line chart
