留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

基于PNI、SII、CAR的列线图模型对肝移植术后腹腔感染的预测价值

罗文婷, 曹丽, 吕德珍, 等. 基于PNI、SII、CAR的列线图模型对肝移植术后腹腔感染的预测价值[J]. 器官移植, 2022, 13(4): 503-508. doi: 10.3969/j.issn.1674-7445.2022.04.014
引用本文: 罗文婷, 曹丽, 吕德珍, 等. 基于PNI、SII、CAR的列线图模型对肝移植术后腹腔感染的预测价值[J]. 器官移植, 2022, 13(4): 503-508. doi: 10.3969/j.issn.1674-7445.2022.04.014
Luo Wenting, Cao Li, Lyu Dezhen, et al. Predictive value of nomogram model based on PNI, SII and CAR for abdominal infection after liver transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(4): 503-508. doi: 10.3969/j.issn.1674-7445.2022.04.014
Citation: Luo Wenting, Cao Li, Lyu Dezhen, et al. Predictive value of nomogram model based on PNI, SII and CAR for abdominal infection after liver transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(4): 503-508. doi: 10.3969/j.issn.1674-7445.2022.04.014

基于PNI、SII、CAR的列线图模型对肝移植术后腹腔感染的预测价值

doi: 10.3969/j.issn.1674-7445.2022.04.014
基金项目: 

国家自然科学基金青年科学基金项目 82102547

江苏省自然科学基金面上项目 BK20181113

详细信息
    作者简介:
    通讯作者:

    吕德珍,女,1984年生,本科,主管护师,Email:lvdezhentg@163.com

  • 中图分类号: R617, R63

Predictive value of nomogram model based on PNI, SII and CAR for abdominal infection after liver transplantation

More Information
  • 摘要:   目的  探讨原位肝移植术后发生腹腔感染的危险因素。  方法  回顾性分析284例原位肝移植受者的临床资料,根据术后是否发生腹腔感染分为感染组(51例)和非感染组(233例)。采用单因素和多因素logistic回归分析腹腔感染的危险因素,构建列线图预测模型并评估模型预测效果,分析连续性变量对腹腔感染的预测价值。  结果  284例受者中,51例发生腹腔感染,发生率为18.0%。术前有糖尿病[比值比(OR)2.66,95%可信区间(CI)1.13~6.14,P=0.013]、手术时间长(OR 1.98,95%CI 1.03~3.57,P=0.038)、预后营养指数(PNI)低(OR 2.18,95%CI 1.06~4.44,P=0.023)、全身免疫炎症指数(SII)高(OR 2.21,95%CI 1.06~4.78,P=0.012)、C-反应蛋白/白蛋白比值(CAR)高(OR 1.90,95%CI 1.05~3.49,P=0.029)是肝移植术后腹腔感染的独立危险因素。列线图模型预测肝移植术后腹腔感染的曲线下面积(AUC)为0.761,且模型标准,一致性较好。CAR、PNI、SII均为肝移植术后腹腔感染的预测因子(均为P < 0.05),AUC分别为0.648、0.611和0.648,临界值分别为2.75、43.15和564.50。  结论  CAR、SII、PNI是肝移植术后腹腔感染的预测因子,基于PNI、SII、CAR构建的列线图模型可有效预测肝移植术后腹腔感染的发生。

     

  • 图  1  预测肝移植术后腹腔感染的列线图模型

    Figure  1.  Nomogram model for predicting abdominal infection after liver transplantation

    图  2  肝移植术后腹腔感染预测模型的ROC曲线

    Figure  2.  ROC curve of prediction model of abdominal infection after liver transplantation

    图  3  肝移植术后腹腔感染预测模型的DCA曲线

    Figure  3.  DCA curve of prediction model of abdominal infection after liver transplantation

    图  4  肝移植术后腹腔感染预测模型的Calibration曲线

    Figure  4.  Calibration curve of prediction model of abdominal infection after liver transplantation

    图  5  CAR、PNI、SII及手术时间对腹腔感染预测价值ROC曲线分析

    注:A图为CAR诊断肝移植术后腹腔感染的ROC曲线;B图为PNI诊断肝移植术后腹腔感染的ROC曲线;C图为SII诊断肝移植术后腹腔感染的ROC曲线;D图为手术时间诊断肝移植术后腹腔感染的ROC曲线。

    Figure  5.  ROC curves analysis of predictive value of CAR, PNI, SII and operation time for abdominal infection

  • [1] DAMIAN MA, HAMMER GB, ELKOMY MH, et al. Pharmacokinetics of dexmedetomidine in infants and Children after orthotopic liver transplantation[J]. Anesth Analg, 2020, 130(1): 209-216. DOI: 10.1213/ANE.0000000000003761.
    [2] REARDON LC, LIN JP, VANARSDELL GS, et al. Orthotopic heart and combined heart liver transplantation: the ultimate treatment option for failing fontan physiology[J]. Curr Transplant Rep, 2021, DOI: 10.1007/s40472-021-00315-4[Epubaheadofprint].
    [3] LING L, HE X, ZENG J, et al. Retraction note: in-hospital cerebrovascular complications following orthotopic liver transplantation: a retrospective study[J]. BMC Neurol, 2021, 21(1): 155. DOI: 10.1186/s12883-021-02175-y.
    [4] ANTUNES M, TEIXEIRA A, FORTUNA P, et al. Infections after liver transplantation: a retrospective, single-center study[J]. Transplant Proc, 2015, 47(4): 1019-1024. DOI: 10.1016/j.transproceed.2015.03.009.
    [5] KIM SI, KIM YJ, CHOI JY, et al. Strategies to reduce infectious complication using epidemiologic data analysis in liver transplant recipients[J]. Transplant Proc, 2013, 45(8): 3061-3064. DOI: 10.1016/j.transproceed.2013.08.072.
    [6] PATEL G, HUPRIKAR S. Infectious complications after orthotopic liver transplantation[J]. Semin Respir Crit Care Med, 2012, 33(1): 111-124. DOI: 10.1055/s-0032-1301739.
    [7] 中华医学会肝病学分会. 肝硬化诊治指南[J]. 中华肝脏病杂志, 2019, 27(11): 846-865. DOI: 10.3760/cma.j.issn.1007-3418.2019.11.008.

    Branch of Hepatology of Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. Chin J Hepatol, 2019, 27(11): 846-865. DOI: 10.3760/cma.j.issn.1007-3418.2019.11.008.
    [8] ZHU S, CHENG Z, HU Y, et al. Prognostic value of the systemic immune-inflammation index and prognostic nutritional index in patients with medulloblastoma undergoing surgical resection[J]. Front Nutr, 2021, 8: 754958. DOI: 10.3389/fnut.2021.754958.
    [9] BALDWIN N, GRAY M, PATEL CR, et al. Acute liver failure due to toxoplasmosis after orthotopic liver transplantation[J]. J Investig Med High Impact Case Rep, 2021, 9: 23247096211014691. DOI: 10.1177/23247096211014691.
    [10] SONG W, CHEN C, HUANG Y, et al. Living donor liver transplantation for pediatric patients with metabolic disease vs. deceased donation[J]. Asian J Surg, 2021, 44(4): 629-635. DOI: 10.1016/j.asjsur.2020.11.016.
    [11] 李瀚, 贾亚男, 贺强, 等. 危重症肝病肝移植术后免疫抑制剂管理和感染的防治进展[J]. 器官移植, 2020, 11(3): 344-349. DOI: 10.3969/j.issn.1674-7445.2020.03.004.

    LI H, JIA YN, HE Q, et al. Progress of immunosuppressant management, infection prevention and treatment after liver transplantation in severe liver disease[J]. Organ Transplant, 2020, 11(3): 344-349. DOI: 10.3969/j.issn.1674-7445.2020.03.004.
    [12] 申存毅, 薛峰, 李亚鹏, 等. 肝移植后发生腹腔感染的危险因素分析[J]. 中华消化外科杂志, 2021, 20(11): 1184-1190. DOI: 10.3760/cma.j.cn115610-20211008-00491.

    SHEN CY, XUE F, LI YF, et al. Risk factors analysis of abdominal infection after liver transplantation[J]. Chin J Dig Surg, 2021, 20(11): 1184-1190. DOI: 10.3760/cma.j.cn115610-20211008-00491.
    [13] HELLINGER WC, CROOK JE, HECKMAN MG, et al. Surgical site infection after liver transplantation: risk factors and association with graft loss or death[J]. Transplantation, 2009, 87(9): 1387-1393. DOI: 10.1097/TP.0b013e3181a25133.
    [14] 吕少诚, 王苑, 潘冰, 等. 肝移植术后腹腔感染的相关危险因素分析[J]. 解放军医学院学报, 2019, 40(1): 16-19. https://www.cnki.com.cn/Article/CJFDTOTAL-JYJX201901005.htm

    LYU SC, WANG Y, PAN B, et al. Risk factors of abdominal infection after liver transplantation[J]. Acad J Chin PLA Med Sch, 2019, 40(1): 16-19. https://www.cnki.com.cn/Article/CJFDTOTAL-JYJX201901005.htm
    [15] KOBER P, GOZDOWSKA J, SAWICKA M, et al. Cutaneous nocardiosis in a liver transplant recipient - case report[J]. Pol Merkur Lekarski, 2020, 48(284): 108-111.
    [16] OOMMEN T, ARUN CS, KUMAR H, et al. Incidence of new-onset diabetes and posttransplant metabolic syndrome after liver transplantation - a prospective study from South India[J]. Indian J Endocrinol Metab, 2020, 24(2): 165-169. DOI: 10.4103/ijem.IJEM_602_19.
    [17] BÖHLER M, VAN DEN BERG EH, ALMANZA MCT, et al. Branched chain amino acids are associated with metabolic complications in liver transplant recipients[J]. Clin Biochem, 2022, 102: 26-33. DOI: 10.1016/j.clinbiochem.2022.01.009.
    [18] NASCIMENTO JCR, PEREIRA LC, RÊGO JMC, et al. Apolipoprotein E polymorphism influences orthotopic liver transplantation outcomes in patients with hepatitis C virus-induced liver cirrhosis[J]. World J Gastroenterol, 2021, 27(11): 1064-1075. DOI: 10.3748/wjg.v27.i11.1064.
    [19] ABU-ASHOUR W, TWELLS LK, VALCOUR JE, et al. Diabetes and the occurrence of infection in primary care: a matched cohort study[J]. BMC Infect Dis, 2018, 18(1): 67. DOI: 10.1186/s12879-018-2975-2.
    [20] MATSUDA T, UMEDA Y, MATSUDA T, et al. Preoperative prognostic nutritional index predicts postoperative infectious complications and oncological outcomes after hepatectomy in intrahepatic cholangiocarcinoma[J]. BMC Cancer, 2021, 21(1): 708. DOI: 10.1186/s12885-021-08424-0.
    [21] KIM CY, KIM SY, SONG JH, et al. Usefulness of the preoperative prognostic nutritional index score as a predictor of the outcomes of lung transplantation: a single-institution experience[J]. Clin Nutr, 2019, 38(5): 2423-2429. DOI: 10.1016/j.clnu.2018.10.027.
    [22] YANG YL, WU CH, HSU PF, et al. Systemic immune-inflammation index (SⅡ) predicted clinical outcome in patients with coronary artery disease[J]. Eur J Clin Invest, 2020, 50(5): e13230. DOI: 10.1111/eci.13230.
    [23] OKITA Y, ARAKI T, OKUGAWA Y, et al. The prognostic nutritional index for postoperative infectious complication in patients with ulcerative colitis undergoing proctectomy with ileal pouch-anal anastomosis following subtotal colectomy[J]. J Anus Rectum Colon, 2019, 3(2): 91-97. DOI: 10.23922/jarc.2018-032.
    [24] ADIGUZEL A, ARSAVA EM, TOPCUOGLU MA. Temporal course of peripheral inflammation markers and indexes following acute ischemic stroke: prediction of mortality, functional outcome, and stroke-associated pneumonia[J]. Neurol Res, 2022, 44(3): 224-231. DOI: 10.1080/01616412.2021.1975222.
    [25] REN B, CHEN X, LEI P, et al. The relationship between preoperative systemic immune inflammation index and prognostic nutritional index and the prognosis of patients with alveolar hydatid disease[J]. Front Immunol, 2021, 12: 691364. DOI: 10.3389/fimmu.2021.691364.
    [26] KAPLAN M, ATES I, AKPINAR MY, et al. Predictive value of C-reactive protein/albumin ratio in acute pancreatitis[J]. Hepatobiliary Pancreat Dis Int, 2017, 16(4): 424-430. DOI: 10.1016/S1499-3872(17)60007-9.
    [27] DONLON NE, MOHAN H, FREE R, et al. Predictive value of CRP/albumin ratio in major abdominal surgery[J]. Ir J Med Sci, 2020, 189(4): 1465-1470. DOI: 10.1007/s11845-020-02238-y.
    [28] JIANG W, SHI H, DENG X, et al. The incidence of incision infections after lumbar fusion and the significance of dynamically monitoring serum albumin and C-reactive protein levels[J]. Ann Palliat Med, 2021, 10(10): 10870-10877. DOI: 10.21037/apm-21-2512.
    [29] CHAO JS, ZHAO SL, OU-YANG SW, et al. Post-transplant infection improves outcome of hepatocellular carcinoma patients after orthotopic liver transplantation[J]. World J Gastroenterol, 2019, 25(37): 5630-5640. DOI: 10.3748/wjg.v25.i37.5630.
    [30] AYKOTA MR, SARI T, YILMAZ S. Successful treatment of extreme drug resistant Acinetobacter baumannii infection following a liver transplant[J]. J Infect Dev Ctries, 2020, 14(4): 408-410. DOI: 10.3855/jidc.11842.
  • 加载中
图(6)
计量
  • 文章访问数:  285
  • HTML全文浏览量:  151
  • PDF下载量:  67
  • 被引次数: 0
出版历程
  • 收稿日期:  2022-02-28
  • 网络出版日期:  2022-07-14
  • 刊出日期:  2022-07-15

目录

    /

    返回文章
    返回