Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
Tianjin Neurological Institute, Key Laboratory of Post Neuro-Injury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin, China.
Front Cell Infect Microbiol. 2023 Apr 25;13:1152512. doi: 10.3389/fcimb.2023.1152512. eCollection 2023.
Pulmonary infection caused by multidrug-resistant (MDR-AB) is a common and serious complication after brain injury. There are no definitive methods for its prediction and it is usually accompanied by a poor prognosis. This study aimed to construct and evaluate a nomogram based on patient data from the neurosurgical intensive care unit (NSICU) to predict the probability of MDR-AB pulmonary infection.
In this study, we retrospectively collected patient clinical profiles, early laboratory test results, and doctors' prescriptions (66 variables). Univariate and backward stepwise regression analyses were used to screen the variables to identify predictors, and a nomogram was built in the primary cohort based on the results of a logistic regression model. Discriminatory validity, calibration validity, and clinical utility were evaluated using validation cohort 1 based on receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA). For external validation based on predictors, we prospectively collected information from patients as validation cohort 2.
Among 2115 patients admitted to the NSICU between December 1, 2019, and December 31, 2021, 217 were eligible for the study, including 102 patients with MDR-AB infections (102 cases) and 115 patients with other bacterial infections (115 cases). We randomly categorized the patients into the primary cohort (70%, N=152) and validation cohort 1 (30%, N=65). Validation cohort 2 consisted of 24 patients admitted to the NSICU between January 1, 2022, and March 31, 2022, whose clinical information was prospectively collected according to predictors. The nomogram, consisting of only six predictors (age, NSICU stay, Glasgow Coma Scale, meropenem, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio), had significantly high sensitivity and specificity (primary cohort AUC=0.913, validation cohort 1 AUC=0.830, validation cohort 2 AUC=0.889) for early identification of infection and had great calibration (validation cohort 1,2 P=0.3801, 0.6274). DCA confirmed that the nomogram is clinically useful.
Our nomogram could help clinicians make early predictions regarding the onset of pulmonary infection caused by MDR-AB and implement targeted interventions.
颅脑损伤后，由耐多药（MDR-AB）引起的肺部感染是一种常见且严重的并发症。目前尚无明确的预测方法，且通常预后较差。本研究旨在构建并评估一个基于神经外科重症监护病房（NSICU）患者数据的列线图，以预测 MDR-AB 肺部感染的概率。
本研究回顾性收集了患者的临床特征、早期实验室检查结果和医生处方（共 66 个变量）。采用单因素和逐步后退回归分析筛选变量，以确定预测因子，并基于 logistic 回归模型的结果在主要队列中构建列线图。使用验证队列 1 的受试者工作特征曲线、校准曲线和决策曲线分析（DCA）评估判别效度、校准效度和临床实用性。基于预测因子进行外部验证时，前瞻性地收集了验证队列 2 中患者的信息。
在 2019 年 12 月 1 日至 2021 年 12 月 31 日期间入住 NSICU 的 2115 名患者中，共有 217 名患者符合研究条件，包括 102 例 MDR-AB 感染患者（102 例）和 115 例其他细菌感染患者（115 例）。我们将患者随机分为主要队列（70%，N=152）和验证队列 1（30%，N=65）。验证队列 2 由 2022 年 1 月 1 日至 2022 年 3 月 31 日期间入住 NSICU 的 24 名患者组成，根据预测因子前瞻性地收集了他们的临床信息。该列线图仅包含 6 个预测因子（年龄、NSICU 住院时间、格拉斯哥昏迷评分、美罗培南、中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值），对感染的早期识别具有显著的高灵敏度和特异性（主要队列 AUC=0.913，验证队列 1 AUC=0.830，验证队列 2 AUC=0.889），且校准效果良好（验证队列 1，2 P=0.3801，0.6274）。DCA 证实该列线图具有临床实用性。
本研究构建的列线图有助于临床医生早期预测 MDR-AB 引起的肺部感染，并实施针对性干预。
