摘要
目的探讨原位肝移植患者术后早期发生肺部感染的相关危险因素,并构建肝移植术后早期肺部感染的预测模型。方法回顾性分析首次行原位肝移植的269例患者的临床资料,根据术后30 d内是否发生肺部感染分为感染组(97例)和未感染组(172例),收集患者术前一般资料、术前实验室检查结果、术中和术后资料。采用多因素Logistic回归分析肺部感染的危险因素,基于多因素分析结果构建预测模型并评估模型预测效能。结果2组经单因素和多因素Logistic回归分析,术前预后营养指数(PNI)≤41.70(OR=1.972,95%CI:1.047~3.714,P=0.036)、淋巴细胞计数与单核细胞计数比值(LMR)≤1.52(OR=2.020,95%CI:1.102~3.705,P=0.023)、终末期肝病模型(MELD)>10.72(OR=1.985,95%CI:1.103~3.573,P=0.022)、手术时间>448 min(OR=2.676,95%CI:1.515~4.727,P=0.001)、重症监护病房(ICU)住院时间>4.0 d(OR=2.623,95%CI:1.335~5.154,P=0.005)是肝移植术后早期肺部感染的独立危险因素。基于多因素分析结果构建的预测模型的受试者工作特征曲线下面积为0.768,敏感度为80.41%,特异度为60.47%。结论基于PNI、LMR、MELD、手术时间、ICU住院时间构建的预测模型可有效预测肝移植术后早期肺部感染的发生。
Objective To explore risk factors of early lung infection after liver transplantation and to construct a prediction model of early lung infection after liver transplantation.Methods The clinical data of 269 patients who underwent orthotopic liver transplantation for the first time were retrospectively analyzed.Patients were divided into the infected group(n=97)and the non-infected group(n=172)according to whether pulmonary infection occurred within 30 days after operation.The preoperative general data,preoperative laboratory examination results,intraoperative and postoperative data of the patients were collected.Multivariate Logistic regression analysis were used to screen risk factors of pulmonary infection.Based on the results of multivariate analysis,the prediction model was constructed and the prediction efficiency of the model was evaluated.Results Univariate and multivariate Logistic regression analysis showed that preoperative PNI≤41.70(OR=1.972,95%CI:1.047-3.714,P=0.036),LMR≤1.52(OR=2.020,95%CI:1.102-3.705,P=0.023),MELD score>10.72(OR=1.985,95%CI:1.103-3.573,P=0.022),operative time>448.00 min(OR=2.676,95%CI:1.515-4.727,P=0.001)and intensive care unit(ICU)hospitalization time>4.0 days(OR=2.623,95%CI:1.335-5.154,P=0.005)were independent risk factors for early pulmonary infection after liver transplantation.The ROC area under the curve(AUC)of the prediction model based on the results of multivariate Logistic regression analysis was 0.768,the sensitivity was 80.41%and the specificity was 60.47%.Conclusion The prediction model based on PNI,LMR,MELD score,operation time and ICU hospitalization time can effectively predict the occurrence of early pulmonary infection after liver transplantation.
作者
杨凯
侯丁聪
段少先
毕怡
谢炎
张骊
蒋文涛
YANG Kai;HOU Dingcong;DUAN Shaoxian;BI Yi;XIE Yan;ZHANG Li;JIANG Wentao(The First Central Clinical School,Tianjin Medical University,Tianjin 300192,China;Department of Liver Transplantation,Tianjin First Central Hospital;Tianjin Key Laboratory of Molecular Diagnosis and Treatment of Liver Cancer,Tianjin First Central Hospital)
出处
《天津医药》
CAS
2024年第10期1041-1045,共5页
Tianjin Medical Journal
基金
国家自然科学基金青年项目(82202399)
细胞生态海河实验室创新基金(22HHXBJC00001)。
关键词
肝移植
手术后并发症
预后营养指数
淋巴细胞单核细胞比值
终末期肝病模型
预测模型
liver transplantation
postoperative complications
prognostic nutritional index
lymphocyte-monocyte ratio
model for end-stage liver disease
predictive model
