用于脑深部刺激相关感染的预测列线图。

Predictive nomogram for deep brain stimulation-related infections.

机构信息

1Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), Qingdao, Shandong Province.

2Department of Neurosurgery, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, Shandong Province; and.

出版信息

Neurosurg Focus. 2022 Dec;53(6):E8. doi: 10.3171/2022.9.FOCUS21558.

DOI:10.3171/2022.9.FOCUS21558

PMID:36455280

Abstract

OBJECTIVE

Infection is one of the important and frequent complications following implantable pulse generator and deep brain stimulation (DBS) electrode insertion. The goal of this study was to retrospectively evaluate and identify potential risk factors for DBS infections.

METHODS

From January 2015 to January 2021 in Qingdao municipal hospital (training cohort) and The First Affiliated Hospital of the University of Science and Technology of China (validation cohort), the authors enrolled patients with Parkinson disease who had undergone primary DBS placement or implantable pulse generator replacement. The cases were divided into infection or no-infection groups according to the 6-month follow-up. The authors used the logistic regression models to determine the association between the variables and DBS infection. Depending on the results of logistic regression, the authors established a nomogram. The calibration curves, receiver operating characteristic curve analysis, and decision curves were used to evaluate the reliability of the nomogram.

RESULTS

There were 191 cases enrolled in the no-infection group and 20 cases in the infection group in the training cohort. The univariate logistic regression showed that BMI, blood glucose, and albumin were all significant predictors of infection after DBS surgery (OR 0.832 [p = 0.009], OR 1.735 [p < 0.001], and OR 0.823 [p = 0.001], respectively). In the crude, adjust I, and adjust II models, the three variables stated above were all considered to be significant predictors of infection after DBS surgery. The calibration curves in both training and validation cohorts showed that the predicted outcome fitted well to the observed outcome (p > 0.05). The decision curves showed that the nomogram had more benefits than the "All or None" scheme. The areas under the curve were 0.93 and 0.83 in the training and validation cohorts, respectively.

CONCLUSIONS

The nomogram included BMI, blood glucose, and albumin, which were significant predictors of infection in patients with DBS surgery. The nomogram was reliable for clinical application.

摘要

目的

感染是植入式脉冲发生器和深部脑刺激（DBS）电极植入后常见且重要的并发症之一。本研究旨在回顾性评估并确定 DBS 感染的潜在危险因素。

方法

本研究纳入了 2015 年 1 月至 2021 年 1 月期间在青岛市立医院（训练队列）和中国科学技术大学第一附属医院（验证队列）接受首次 DBS 植入或植入式脉冲发生器更换的帕金森病患者。根据 6 个月的随访结果，将患者分为感染组和未感染组。采用逻辑回归模型确定变量与 DBS 感染的相关性。根据逻辑回归的结果，建立了一个列线图。通过校准曲线、受试者工作特征曲线分析和决策曲线评估了该列线图的可靠性。

结果

在训练队列中，未感染组有 191 例，感染组有 20 例。单因素逻辑回归显示，BMI、血糖和白蛋白均为 DBS 手术后感染的显著预测因素（OR 0.832，p=0.009；OR 1.735，p＜0.001；OR 0.823，p=0.001）。在原始、调整 I 和调整 II 模型中，上述三个变量均被认为是 DBS 手术后感染的显著预测因素。在训练和验证队列中，校准曲线均表明预测结果与观察结果吻合良好（p＞0.05）。决策曲线表明，该列线图比“全有或全无”方案更具优势。训练队列和验证队列的曲线下面积分别为 0.93 和 0.83。