新生儿晚发型大肠埃希菌败血症的危险因素分析及风险预警模型的构建

Analysis of risk factors and construction of risk warning model for late-onset Escherichia coli sepsis in newborns

摘要

目的 探讨新生儿晚发型大肠埃希菌败血症的危险因素,并构建新生儿晚发型大肠埃希菌败血症的列线图模型。方法 选取2021年1月至2023年7月安徽医科大学附属阜阳人民医院收治的226例新生儿作为模型组,另收集2021年8月至2023年10月同院收治的100例新生儿作为验证组.采用Logistic回归分析新生儿晚发型大肠埃希菌败血症的危险因素,采用R软件构建新生儿晚发型大肠埃希菌败血症的列线图模型,并进行模型验证。结果 与无晚发型大肠埃希菌败血症组相比,晚发型大肠埃希菌败血症组胎龄较小、机械通气占比高、出生体重较低、肠外营养占比高、胎膜早破时间长、长时间抗生素暴露占比高,差异均有统计学意义(χ²/t值介于6.089~11.605之间,P<0.05);Logistic回归分析结果显示,胎龄<37周、机械通气、低出生体重、肠外营养、胎膜早破时间较长及长时间抗生素暴露等是新生儿晚发型大肠埃希菌败血症的危险因素,其OR值及95%CI分别为4.031(1.492~10.982)、3.064(1.306~7.188)、3.262(1.200~8.873)、2.852(1.092~7.450)、1.517(1.275~1.806)、2.947(1.216~7.140),P<0.05;模型组和验证组的校正曲线均显示预测值与实际值基本吻合;模型组的受试者工作特征(ROC)曲线下面积是0.856(0.820~0.892),验证组的曲线下面积是0.846(0.800~0.893);模型组及验证组的决策曲线显示阈值概率分别是1%~100%、1%~98%时,列线图预测新生儿晚发型大肠埃希菌败血症的净获益值较高。结论 胎龄<37周、机械通气、低出生体重、肠外营养、胎膜早破时间较长及长时间抗生素暴露等是新生儿晚发型大肠埃希菌败血症的危险因素,新生儿晚发型大肠埃希菌败血症的列线图模型具有较高的准确性及临床应用价值.

Abstract

Objective To explore risk factors of late-onset Escherichia coli sepsis in newborns and construct a column chart model for the late-onset Escherichia coli sepsis in newborns. Methods A total of 226 neonates who admitted to our hospital from January 2021 to July 2023 were selected as the model group, and another 100 neonates who admitted to our hospital over a period from August 2021 to October 2023 were selected as the verification group. Logistic regression was used to analyze risk factors for neonatal late-onset Escherichia coli sepsis, and R software was used to build a column chart model for late-onset Escherichia coli sepsis in newborns and the model was verified. Results There were significant differences in gestational age, mechanical ventilation, birth weight, parenteral nutrition, premature rupture of membranes and long-term antibiotic exposure between the late-onset Escherichia coli septicemia group and the non-late-onset Escherichia coli septicemia group (χ²=11.492, 11.605, 10.748, 11.494, 6.089 and 7.222 respectively, all P<0.05). That was, compared with the non-late-onset Escherichia coli septicemia group, the neonates in the late-onset Escherichia coli septicemia group had lower gestational age, higher proportion of mechanical ventilation, lower birth weight, higher proportion of parenteral nutrition, longer duration of premature rupture of membranes and longer antibiotic exposure. Logistic regression analysis showed that gestational age <37 weeks (OR=4.031, 95%CI: 1.492-10.982), mechanical ventilation (OR=3.064, 95%CI: 1.306-7.188), low birth weight (OR=3.262, 95%CI: 1.200-8.873), parenteral nutrition (OR=2.852, 95%CI: 1.092-7.450), long time of premature rupture of membranes (OR=1.517, 95%CI: 1.275-1.806) and prolonged antibiotic exposure (OR=2.947, 95%CI: 1.216-7.140) were risk factors for late-onset Escherichia coli septicemia in newborns (all P<0.05). The calibration curves in both the model group and the verification group showed that the predictive values were basically consistent with the actual values. The area under ROC curve of the model group was 0.856 (95%CI: 0.820-0.892), and that of the verification group was 0.846 (95%CI: 0.800-0.893). The decision curve analysis showed that when the threshold probability were at 1% to 100% in the model group and 1% to 98% in the verification group, the net benefit values of the nomogram for predicting neonatal late-onset Escherichia coli sepsis were higher. Conclusion Gestational age <37 weeks, mechanical ventilation, low birth weight, parenteral nutrition, long time of premature rupture of membranes and prolonged antibiotic exposure are risk factors for neonatal late-onset Escherichia coli sepsis. The nomogram model of neonatal late-onset Escherichia coli sepsis is of high accuracy and clinical application value.

关键词

新生儿 / 大肠埃希菌 / 晚发型败血症 / 危险因素 / 列线图

Key words

newborn / Escherichia coli / late-onset sepsis / risk factor / nomogram

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