Lu Xun, Jiang Hua, Wang Dong, Wang Yiduo, Chen Qi, Chen Shuqiu, Chen Ming
Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China.
Surgical Research Center, Institute of Urology, School of Medicine, Southeast University, Nanjing, China.
Front Surg. 2022 Jan 21;8:782029. doi: 10.3389/fsurg.2021.782029. eCollection 2021.
To develop and validate a nomogram of the 90-day urinary tract infection (UTI) risk for patients with bladder cancer undergoing radical cystectomy (RC) and urinary diversion.
The predictive nomogram was based on a retrospective study on the consecutive patients who underwent RC and urinary diversion for bladder cancer between January 2014 and March 2021. The incidence and microbiology of UTI were reported. The univariate and multivariate logistic analyses were conducted to determine independent risk factors associated with UTI. The predictive accuracy and discriminatory ability of the established nomogram were evaluated by the concordance index (C-index) and decision curve analysis (DCA). The performance of the model was validated internally.
A total of 220 patients were included and the incidence of UTI within 90 days was 27.3%. The most commonly identified pathogens were (42.0%), (21.70%), and (13.0%). Urinary diversion type, Charlson comorbidities index (CCI), stricture, and prognostic nutritional index (PNI) were included in the nomogram. The C-index of the nomogram for predicting UTI was 0.858 (95% CI: 0.593-0.953). In the validation cohort, the nomogram also showed high-predictive accuracy. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) index indicated that PNI led to improvement in predictive ability.
The proposed early warning model shows great accuracy in predicting the incidence of 90-day UTI after RC and urinary diversion in patients with bladder cancer.
建立并验证用于预测接受根治性膀胱切除术（RC）及尿流改道的膀胱癌患者90天内发生尿路感染（UTI）风险的列线图。
该预测列线图基于一项对2014年1月至2021年3月期间因膀胱癌接受RC及尿流改道的连续患者的回顾性研究。报告了UTI的发生率及微生物学情况。进行单因素和多因素逻辑回归分析以确定与UTI相关的独立危险因素。通过一致性指数（C指数）和决策曲线分析（DCA）评估所建立列线图的预测准确性和鉴别能力。对模型的性能进行内部验证。
共纳入220例患者，90天内UTI的发生率为27.3%。最常见的病原体为（42.0%）、（21.70%）和（13.0%）。列线图纳入了尿流改道类型、Charlson合并症指数（CCI）、狭窄和预后营养指数（PNI）。预测UTI的列线图的C指数为0.858（95%CI：0.593 - 0.953）。在验证队列中，列线图也显示出较高的预测准确性。净重新分类改善（NRI）和综合鉴别改善（IDI）指数表明PNI可提高预测能力。
所提出的预警模型在预测膀胱癌患者RC及尿流改道后90天UTI发生率方面显示出很高的准确性。
