Cobo-Sánchez José Luis, Blanco-Mavillard Ian, Pelayo-Alonso Raquel, Mancebo-Salas Noelia, Fernández-Fernández Ismael, Larrañeta-Inda Irene, Ulzurrun-García Ana, Sánchez-Villar Isidro, González-García Fernando, Hernando-García Julia, Rollán-de la Sota Ma Jesús, Vieira-Barbosa Lopes Luís Miguel, Prieto-Rebollo Ma Del Rosario, Sesmero-Ramos Carolina, Jaume-Riutort Catalina, Casas-Cuesta Rafael, Alcántara-Crespo Mateo, Ernest de Pedro-Gómez Joan
Nursing Research Unit and Nephrology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
Immunopathology Research Group, Marqués de Valdecilla Institute for Health Research, Santander, Spain.
Kidney Int Rep. 2024 Jun 28;9(9):2739-2749. doi: 10.1016/j.ekir.2024.06.034. eCollection 2024 Sep.
Exit-site infections (ESI) of central venous catheters for hemodialysis (CVC-HD) has been associated with early catheter removal and an increased risk of CVC-HD related bacteremia. No specific clinical scales to predict ESI have previously been validated.
A multicenter prospective cohort study was performed to validate the proposed scale, which is based on the following 5 signs and symptoms: (i) pain at exit site during interdialytic period; (ii) hyperemia or erythema ≥2 cm from exit site; (iii) inflammation, induration, or swelling at exit site; (iv) fever ≥38 °C not attributable to other causes, and (v) obvious abscess or purulent exudate at the exit site. Adult patients with a tunneled CVC-HD for at least 1 month after insertion has been included. During each hemodialysis session, the exit site was assessed with the proposed scale by nurses. If any item was present, a pericatheter skin swab culture was collected: positive results were gold standard. The scale was validated using receiver operating characteristic (ROC) curves and logistic regression analysis. For this purpose, the logit function was applied, and the ESI probability calculated, as elogit ESI/1 + elogit ESI.
Three hundred thirty-seven CVC-HDs from 310 patients were analyzed, producing 515 cultures (117 infected and 398 healthy). The final version of the scale includes the following 3 signs and symptoms, which present the greatest predictive capacity: (i) pain at exit site during interdialytic period, (ii) hyperemia or erythema ≥2 cm from exit site, and (iii) abscess or purulent exudate at the exit site. The final version generated an area under the ROC curve (AUC) of 88.3% (95% confidence interval [CI]: 85.2%-91%; < 0.001), Youden index 0.7557 ≈ 1, sensitivity 80.34% (95% CI: 71.36%-87.71%) and specificity 95.23% (95% CI: 92.73%-97%).
The validation shows that the scale has good predictive properties, detecting approximately 90% of ESI with very acceptable validity parameters.
血液透析中心静脉导管（CVC-HD）的出口部位感染（ESI）与导管早期拔除以及CVC-HD相关菌血症风险增加有关。此前尚无经过验证的预测ESI的特定临床量表。
进行了一项多中心前瞻性队列研究，以验证所提议的量表，该量表基于以下5种体征和症状：（i）透析间期出口部位疼痛；（ii）出口部位2 cm以外的充血或红斑；（iii）出口部位炎症、硬结或肿胀；（iv）体温≥38°C且无其他原因可解释，以及（v）出口部位有明显脓肿或脓性渗出物。纳入插入隧道式CVC-HD至少1个月后的成年患者。在每次血液透析过程中，护士使用所提议的量表对出口部位进行评估。如果出现任何一项，采集导管周围皮肤拭子培养：阳性结果为金标准。使用受试者工作特征（ROC）曲线和逻辑回归分析对该量表进行验证。为此，应用对数函数，并计算ESI概率，即elogit ESI/1 + elogit ESI。
分析了310例患者的337根CVC-HD，共进行了515次培养（117次感染和398次正常）。该量表的最终版本包括以下3种体征和症状，其预测能力最强：（i）透析间期出口部位疼痛；（ii）出口部位2 cm以外的充血或红斑；（iii）出口部位脓肿或脓性渗出物。最终版本的ROC曲线下面积（AUC）为88.3%（95%置信区间[CI]：85.2%-91%；P<0.001），约登指数0.7557≈1，灵敏度80.34%（95%CI：71.36%-87.71%），特异性95.23%（95%CI：92.73%-97%）。
验证表明该量表具有良好的预测特性，能以非常可接受的有效性参数检测出约90%的ESI。
