Establishment and effect evaluation of risk prediction model for lung infection after kidney transplantation
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摘要:
目的 探讨肾移植受者术后1年内发生肺部感染风险预测模型的构建及其预测价值。 方法 回顾性分析197例肾移植受者的临床资料,根据术后1年内是否发生肺部感染分为感染组(42例)和非感染组(155例)。分析肾移植术后肺部感染的发生情况及危险因素,利用多元logistic回归分析建立风险预测模型。选取符合标准的45例肾移植受者进行验证,其中感染组8例,非感染组37例,验证模型的预测效果。 结果 肾移植术后1年内肺部感染的发生率为21.3%(42例),其中肺炎严重指数(PSI)评级Ⅰ级38例(90%),Ⅲ级1例(2%),Ⅴ级3例(8%)。13例发生于术后1个月内,22例发生于术后2~6个月,7例发生于术后6个月后。细菌感染19例、真菌感染7例、病毒感染10例、混合感染6例。存在吸烟史、糖尿病史、肺部疾病史及白蛋白 < 35 g/L是肾移植受者术后发生肺部感染的独立危险因素(均为P < 0.05)。肾移植受者术后肺部感染风险预测模型方程为logit(肾移植受者术后1年内肺部感染)=-1.891+1.063×吸烟史(有=1,无=0)+1.398×糖尿病史(有=1,无=0)+1.732×肺部疾病史(有=1,无=0)+1.269×白蛋白(< 35 g/L=1,≥35 g/L=0),受试者工作特征(ROC)曲线下面积(AUC)为0.788,灵敏度为0.786,特异度为0.645,约登指数为0.431。Hosmer-Lemeshow拟合优度检验结果显示模型预测值和实际观测值间的一致度较好。验证组AUC为0.834,Hosmer-Lemeshow拟合优度检验结果显示模型校准度较好。 结论 以吸烟史、糖尿病史、肺部疾病史、白蛋白为预测因子构建的模型可有效预测肾移植受者术后1年内肺部感染的发生。 Abstract:Objective To establish and evaluate the predictive value of the risk prediction model for lung infection within postoperative 1 year in kidney transplant recipients. Methods Clinical data of 197 kidney transplant recipients were retrospectively analyzed. All recipients were divided into the infection group (n=42) and non-infection group (n=155) according to the incidence of lung infection within postoperative 1 year. The incidence and risk factors of lung infection after kidney transplantation were analyzed. Risk prediction model was established by multiple logistic regression analysis. Forty-five kidney transplant recipients who met the inclusion criteria, including 8 cases in the infection group and 37 cases in the non-infection group, were selected to verify the predictive effect of the established model. Results The incidence of lung infection within 1 year after kidney transplantation was 21.3% (n=42), including 38 cases (90%) of pneumonia severity index (PSI) class Ⅰ, 1 case (2%) of PSI class Ⅲ and 3 cases (8%) of PSI class Ⅴ. Lung infection occurred within 1 month after operation in 13 cases, within postoperative 2-6 months in 22 cases and after postoperative 6 months in 7 cases. Nineteen recipients were diagnosed with bacterial infection, 7 cases of fungal infection, 10 cases of viral infection and 6 cases of mixed infection. Smoking history, diabetes mellitus history, pulmonary disease history and albumin level of < 35 g/L were the independent risk factors for lung infection after kidney transplantation (all P < 0.05). The equation of risk prediction model for postoperative lung infection in kidney transplant recipients was logit (lung infection within postoperative 1 year in kidney transplant recipients)=-1.891+1.063×smoking history (yes=1, no=0)+1.398×diabetes mellitus history (yes=1, no=0)+1.732×pulmonary disease history (yes=1, no=0)+1.269×albumin level (< 35 g/L=1, ≥35 g/L=0). The area under the curve (AUC) of receiver operating characteristic (ROC) was 0.788, the sensitivity was 0.786, the specificity was 0.645, and the Youden index was 0.431, respectively. Hosmer-Lemeshow goodness-of-fit test demonstrated that the predicted value of this model yielded relatively high consistency with the observed value. The AUC in the verification group was 0.834. Hosmer-Lemeshow goodness-of-fit test validated high degree of calibration of this model. Conclusions The risk prediction model, consisting of smoking history, diabetes mellitus history, pulmonary disease history and albumin level as predictors, may effectively predict the incidence of lung infection within postoperative 1 year in kidney transplant recipients. -
Key words:
- Lung infection /
- Kidney transplantation /
- Risk prediction model /
- Risk factor /
- Pulmonary disease /
- Diabetes mellitus /
- Albumin /
- Smoking
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表 1 肾移植术后发生肺部感染危险因素的单因素分析
Table 1. Univariate analysis of risk factors for pulmonary infection after kidney transplantation
变量 感染组(n=42) 非感染组(n=155) 统计值 P值 变量 感染组(n=42) 非感染组(n=155) 统计值 P值 年龄[M(P25,P75),岁] 43(34,51) 42(34,48) 0.232 0.871 术前透析[n(%)] 0.000 1.000 性别[n(%)] 0.287 0.592 有 41(98) 151(97) 男 30(71) 117(75) 无 1(2) 4(3) 女 12(29) 38(25) 术前诱导方案[n(%)] 0.436 0.509 BMI[n(%)] 0.660 0.509 巴利昔单抗 8(19) 37(24) < 18 kg/m2 13(31) 54(35) 抗人T淋巴细胞球蛋白 34(81) 118(76) 18~24 kg/m2 24(57) 88(57) 围手术期误吸[n(%)] 7.987 0.005 > 24 kg/m2 5(12) 13(8) 有 5(12) 2(1) 吸烟史[n(%)] 14.272 < 0.001 无 37(88) 153(99) 有 22(52) 35(23) 术前使用抗菌药物[n(%)] 0.000 1.000 无 20(48) 120(77) 有 42(100) 154(99) 酗酒史[n(%)] 2.139 0.343 无 0 1(1) 有 2(5) 19(12) 白细胞[n(%)] 1.048 0.295 无 40(95) 136(88) < 4×109/L 1(2) 3(2) 原发疾病病程[n(%)] 1.183 0.237 4~10×109/L 21(50) 64(41) < 1年 3(7) 27(17) > 10×109/L 20(48) 88(57) 2~5年 21(50) 70(45) 淋巴细胞绝对值[n(%)] 0.714 0.475 > 5年 18(43) 58(37) < 0.8×109/L 39(93) 148(95) 供者来源[n(%)] 0.436 0.509 0.8~3.5×109/L 2(5) 7(5) 亲属活体 8(19) 37(24) > 3.5×109/L 1(2) 0 脑死亡供者 34(81) 118(76) 白蛋白[n(%)] 13.391 < 0.001 高血压史[n(%)] 4.265 0.039 < 35 g/L 24(57) 42(27) 有 33(79) 140(90) ≥35 g/L 18(43) 113(73) 无 9(21) 15(10) 血清肌酐[n(%)] 1.527 0.217 糖尿病史[n(%)] 18.891 < 0.001 ≤110 μmoI/L 3(7) 3(2) 有 14(33) 12(8) > 110 μmoI/L 39(93) 152(98) 无 28(67) 143(92) 供肾脓液培养病原菌[n(%)] 0.614 0.433 肺部疾病史[n(%)] 10.311 0.001 有 21(50) 67(43) 有 10(24) 9(6) 无 21(50) 88(57) 无 32(76) 146(94) 注:白细胞、淋巴细胞绝对值、白蛋白、血清肌酐均为肾移植术后第1次测量结果。 表 2 肾移植术后发生肺部感染危险因素的多因素分析
Table 2. Multivariate analysis of risk factors for pulmonary infection after kidney transplantation
危险因素 偏回归系数 标准误 Wald χ2 P值 OR①值 95%CI② 常数项 -1.891 0.585 10.459 0.001 0.151 -③ 吸烟史 1.063 0.423 6.329 0.012 2.896 1.265~6.633 高血压史 -1.050 0.596 3.109 0.078 0.350 0.109~1.124 糖尿病史 1.398 0.522 7.183 0.007 4.407 1.456~11.250 肺部疾病史 1.732 0.567 9.342 0.002 6.121 1.861~17.156 围手术期误吸 2.061 1.122 3.372 0.066 7.851 0.871~70.813 白蛋白 < 35 g/L 1.269 0.425 8.917 0.003 3.566 1.546~8.178 注:①OR为比值比。
②CI为可信区间。
③-为无数据。表 3 模型组和验证组危险因素比较
Table 3. Comparison of risk factors between model group and validation group
变量 模型组(n=197) 验证组(n=45) 统计值 P值 吸烟史[n(%)] 0.245 0.283 有 57(29) 17(38) 无 140(71) 28(62) 糖尿病史[n(%)] 0.626 0.616 有 26(13) 4(9) 无 171(87) 41(91) 肺部疾病史[n(%)] 0.596 0.687 有 42(21) 8(18) 无 155(79) 37(82) 白蛋白[n(%)] 0.586 0.604 < 35 g/L 66(34) 17(38) ≥35 g/L 131(66) 28(62) -
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