完全植入式静脉输液港植入后感染风险的列线图预测模型构建与验证:一项回顾性研究-东南大学学报医学版

完全植入式静脉输液港植入后感染风险的列线图预测模型构建与验证:一项回顾性研究

单位：广州市第一人民医院介入放射科, 广东广州 510180

分类号：R45;R472.1

出版年·卷·期（页码）：2024·43·第三期（395-403）

摘要：

目的:构建并验证列线图预测模型,用于预测完全植入式静脉输液港(TIVAP)植入后的感染风险。方法:对2017年1月至2022年8月,在广州市第一人民医院接受TIVAP植入手术的794例患者进行回顾性分析。通过随机抽样将研究对象按7∶3分为训练集(555例)和验证集(239例)。首先应用LASSO回归分析筛选出最佳预测因素,并将其纳入多因素Logistic回归分析以构建列线图模型。利用受试者工作特征(ROC)曲线、校准曲线和临床决策曲线(DCA)评估预测模型的区分能力、准确性和临床有效性。结果:多因素Logistic回归分析确认年龄、手术时间、血液系统肿瘤和BMI为TIVAP植入后感染的独立影响因素。基于这些因素构建列线图预测模型,ROC曲线分析显示训练集和验证集的AUC值分别为0.948(95%CI:0.914~0.982)和0.935(95%CI:0.876~0.994),表明模型具有良好的区分能力和预测准确性。结论:本研究开发的TIVAP植入后感染风险预测模型在临床上具有实用价值,可以帮助临床评估患者的感染风险,从而制定更加个性化的治疗计划。

Objective: To develop and validate a Nomogram predictive model for estimating the risk of infection following the implantation of a totally implantable venous access ports(TIVAP). Methods:A retrospective analysis was conducted on 794 patients who underwent TIVAP implantation surgery at Guangzhou First People's Hospital from January 2017 to August 2022. Subjects were randomly divided into a training set(555 cases) and a validation set(239 cases) in a 7∶3 ratio. LASSO regression analysis was initially applied to identify the optimal predictive factors, which were then incorporated into a multifactorial Logistic regression to develop the Nomogram model. The predictive model's discriminative ability, accuracy, and clinical utility were assessed using the receiver operating characteristic(ROC) curve, calibration curve, and decision curve analysis(DCA). Results:Multifactorial Logistic regression analysis identified age, operation duration, hematological malignancies, and BMI as independent factors affecting infection after TIVAP implantation. Based on these factors, a Nomogram predictive model was constructed. ROC curve analysis revealed AUC values of 0.948(95%CI:0.914-0.982) and 0.935(95%CI:0.876-0.994) for the training and validation sets, respectively, indicating good discriminative ability and predictive accuracy of the model. Conclusion: The TIVAP post-implantation infection risk predictive model developed in this study has practical clinical value. It can assist clinicians in assessing patient infection risks, thus facilitating the formulation of more personalized treatment plans.

参考文献：

[1] WIENER E S.Totally implanted venous and arterial access system to replace external catheters in cancer treatment[J].Journal of Pediatric Surgery,1983,18(4):528.
[2] PINELLI F,CECERO E,DEGL'INNOCENTI D,et al.Infection of totally implantable venous access devices:a review of the literature[J].The Journal of Vascular Access,2018,19(3):230-242.
[3] VIANA TAVEIRA M R,LIMA L S,DE ARAÚJO C C,et al.Risk factors for central line-associated bloodstream infection in pediatric oncology patients with a totally implantable venous access port:a cohort study[J].Pediatric Blood & Cancer,2016,64(2):336-342.
[4] HSU J F,CHANG H L,TSAI M J,et al.Port type is a possible risk factor for implantable venous access port-related bloodstream infections and no sign of local infection predicts the growth of gram-negative bacilli[J].World Journal of Surgical Oncology,2015,13(1):288.
[5] MAKI D G,KLUGER D M,CRNICH C J.The risk of bloodstream infection in adults with different intravascular devices:a systematic review of 200 published prospective studies[J].Mayo Clinic Proceedings,2006,81(9):1159-1171.
[6] 秦娟,朱海东,陆建,等.¹²⁵I粒子支架置入治疗食管癌术后出血风险因素预测模型建立与验证[J].东南大学学报(医学版),2019,38(1):159-164.
[7] 王海生,陈立文,梁冰,等.急性肺栓塞治疗后短期复发危险因素的分析及列线图预测模型的构建[J].东南大学学报(医学版),2023,42(1):110-115.
[8] ZHANG Y,SHI R,YU L,et al.Establishment of a risk prediction model for non-alcoholic fatty liver disease in type 2 diabetes[J].Diabetes Therapy,2020,11(9):2057-2073.
[9] BECKERS M M J,RUVEN H J T,SELDENRIJK C A,et al.Risk of thrombosis and infections of central venous catheters and totally implanted access ports in patients treated for cancer[J].Thrombosis Research,2010,125(4):318-321.
[10] MANGRAM A J,HORAN T C,PEARSON M L,et al.Guideline for prevention of surgical site infection,1999.Centers for Disease Control and Prevention(CDC) Hospital Infection Control Practices Advisory Committee[J].American Journal of Infection Control,1999,27(2):97-132.
[11] HARRELL F E.Regression modeling strategies [M].New York,NY:Springer New York,2001:1-594.
[12] 中国中西医结合学会外周血管疾病委员会中心静脉通路专家组.静脉输液港植入与管理多学科专家共识(2023版)[J].中国普通外科杂志,2023,32(6):799-814.
[13] 张进泓,罗凤.应用完全植入式静脉输液港病人满意度与生活质量的研究进展[J].护理研究,2019,33(7):1166-1169.
[14] LEE J,HUR S M,KIM Z,et al.Safety of immediate use of totally implantable venous access ports in adult patients with cancer:a retrospective single-center study[J].Korean Journal of Clinical Oncology,2021,17(2):104-110.
[15] GUAN X,YAN H,ZHANG J,et al.Risk factors of infection of totally implantable venous access port:a retrospective study[J].J Vasc Access,2023,24(6):1340-1348.
[16] CHANG T C,YEN M H,KIU K T.Incidence and risk factor for infection of totally implantable venous access port[J].Langenbeck's Archives of Surgery,2021,407(1):343-351.
[17] HSU Y J,LIN K D,CHEN J H,et al.Periodontal treatment experience associated with oral health-related quality of life in patients with poor glycemic control in type 2 diabetes:a case-control study[J].International Journal of Environmental Research and Public Health,2019,16(20):4011.
[18] JI L,YANG J,MIAO J,et al.Infections related to totally implantable venous-access ports:long-term experience in one center[J].Cell Biochemistry and Biophysics,2014,72(1):235-240.
[19] CHENG H,CHEN B P H,SOLEAS I M,et al.Prolonged operative duration increases risk of surgical site infections:a systematic review[J].Surgical Infections,2017,18(6):722-735.
[20] MEIJS A P,KOEK M B G,VOS M C,et al.The effect of body mass index on the risk of surgical site infection[J].Infection Control & Hospital Epidemiology,2019,40(9):991-996.
[21] THELWALL S,HARRINGTON P,SHERIDAN E,et al.Impact of obesity on the risk of wound infection following surgery:results from a nationwide prospective multicentre cohort study in England[J].Clinical Microbiology and Infection,2015,21(11):1008.e1-1008.e8.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录