小儿难治性肺炎支原体肺炎院内感染危险因素分析与疾病预测模型的建立

Analysis of risk factors for nosocomial infection of refractory mycoplasma pneumonia in children and establishment of disease prediction model

摘要

目的 探索小儿难治性肺炎支原体肺炎(RMPP)院内感染的危险因素与疾病预测模型的建立。方法 选取2018年5月至2023年11月廊坊市人民医院150例RMPP患儿为研究对象,分为105例建模组及45例验证组.依据是否发生院内感染分为44例感染组及61例非感染组.收集患儿基础资料,采用Logistic回归分析RMPP患儿发生院内感染的危险因素,利用R软件构建列线图的预测模型,利用受试者工作特征(ROC)曲线、校准曲线、Hosmer-Lemeshow拟合优度检验及决策曲线对构建的列线图预测模型的预测效能进行评估。结果 感染组患儿侵入性操作人数、联合使用抗生素人数、C反应蛋白(CRP)水平均高于非感染患儿,补体C₃水平低于非感染患儿,差异有统计学意义(t/χ²值介于3.679~29.556之间,P<0.05);多因素Logistic回归分析结果显示侵入性操作、联合使用抗生素、CRP高水平是RMPP发生院内感染的危险因素,补体C₃高水平是RMPP发生院内感染的保护因素(OR值分别为2.231、2.883、1.221、0.025,P<0.05);建模组列线图预测RMPP发生院内感染风险的曲线下面积(AUC)为0.875(95%CI:0.830~0.912),灵敏度为89.38%,特异度为77.99%;验证组AUC为0.882(95%CI:0.838~0.918),灵敏度为85.71%,特异度为81.61%;校准曲线与理想曲线拟合度高,预测模型的临床净获益也较高。结论 侵入性操作、联合使用抗生素、CRP及低水平补体C₃均为RMPP患儿发生院内感染的危险因素,据此构建的模型具有较好的区分度及一致性.

Abstract

Objective To analyze risk factors for nosocomial infection of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children and establish a disease prediction model. Methods 150 children with RMPP who were treated in Langfang Municipal People's Hospital from May 2018 to November 2023 were selected as research subjects, and they were divided into modeling group (n=105) and validation group (n=45). According to whether nosocomial infection occurred, the patients in the modeling group were divided into nosocomial infection group (n=44) and non-nosocomial infection group (n=61). The basic data of the children were collected. Logistic regression was used to analyze risk factors of nosocomial infection in children with RMPP. R software was utilized to construct a nomogram prediction model. Receiver operating characteristic (ROC) curve, calibration curve, Hosmer-Lemeshow goodness of fit test and decision curve were used to evaluate prediction efficiency of the nomogram prediction model. Results In the nosocomial infection group, number of children who underwent invasive operations, number of children who received combined use of antibiotics and serum C-reactive protein (CRP) level were higher than those in the non-nosocomial infection group, while serum level of complement C₃ was lower than that in the non-nosocomial infection group, and the difference was statistically significant (t/χ²=3.679-29.556, all P<0.05). Multivariate Logistic regression analysis showed that invasive operation, combined use of antibiotics and high serum level of CRP were risk factors for nosocomial infection in children with RMPP, while high level of complement C₃ was protective factor for nosocomial infection in children with RMPP (OR=2.231, 2.883, 1.221 and 0.025 respectively, all P<0.05). The area under the curve (AUC) for predicting risk of nosocomial infection in children with RMPP was 0.875 (95%CI: 0.830-0.912), the sensitivity was 89.38% and the specificity was 77.99%. In the validation group, the AUC was 0.882 (95%CI: 0.838-0.918), the sensitivity was 85.71% and the specificity was 81.61%. The fitting degree of calibration curve and ideal curve was high, and clinical net benefit of the prediction model was also high. Conclusion Invasive operation, combined use of antibiotics, high serum CRP level and low serum complement C₃ level are risk factors for nosocomial infection in children with RMPP, and the model based on these indexes has good discrimination and consistency.

关键词

儿童 / 难治性肺炎支原体肺炎 / 院内感染 / 危险因素 / 列线图 / 预测模型

Key words

children / refractory Mycoplasma pneumoniae pneumonia / nosocomial infection / risk factor / nomogram / prediction model

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基金资助

廊坊市科学技术研究与发展计划自筹经费项目(2023013060)