Wang Yang-Yang, Wang Wei-Li, Sun Yan, Zhang Wei, Zhang Yun-Tao, Gao Shun-Liang, Wu Jian, Shen Yan, Zhu Zhe-Cheng, Bai Xue-Li, Zhang Qi, Liang Ting-Bo
Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, China.
Department of Surgical Intensive Care Unit, Tianjin First Central Hospital, Tianjin, China.
World J Pediatr. 2025 Sep 9. doi: 10.1007/s12519-025-00973-9.
Carbapenem-resistant Enterobacteriaceae (CRE) infections can pose a significant risk following pediatric liver transplantations. This study aimed to identify risk factors for CRE infections and develop prediction models for pediatric recipients.
This study enrolled pediatric patients who underwent liver transplantation between 2017 and 2023. Risk factors for CRE infection were identified using logistic regression analysis. Prediction models were constructed using a training cohort and validated using internal and external validation cohorts. Predictive performance was assessed using receiver operating characteristic curves and area under the curve (AUC).
CRE intestinal colonization before liver transplantation, bile or intestinal leakage and respiratory ribonucleic acid virus infections were independent risk factors for CRE infection after pediatric liver transplantation. Our prediction model comprising all three factors achieved AUC values of 0.724 and 0.738 in the training and internal validation cohorts, respectively. The AUC of an additional model constructed using CRE intestinal colonization and bile or intestinal leakage achieved 0.738 and 0.828 in the internal and external validation cohorts, respectively. Two nomograms were constructed.
Both nomograms accurately predicted CRE infection after liver transplantation. They can facilitate the adoption of essential protective measures in pediatric liver transplant recipients.
耐碳青霉烯类肠杆菌科细菌（CRE）感染在儿童肝移植后可能构成重大风险。本研究旨在确定CRE感染的危险因素，并为儿童受者建立预测模型。
本研究纳入了2017年至2023年间接受肝移植的儿科患者。使用逻辑回归分析确定CRE感染的危险因素。使用训练队列构建预测模型，并使用内部和外部验证队列进行验证。使用受试者工作特征曲线和曲线下面积（AUC）评估预测性能。
肝移植前CRE肠道定植、胆汁或肠道渗漏以及呼吸道核糖核酸病毒感染是儿童肝移植后CRE感染的独立危险因素。我们包含所有三个因素的预测模型在训练队列和内部验证队列中的AUC值分别为0.724和0.738。使用CRE肠道定植和胆汁或肠道渗漏构建的另一个模型在内部和外部验证队列中的AUC分别为0.738和0.828。构建了两个列线图。
两个列线图均能准确预测肝移植后的CRE感染。它们有助于在儿童肝移植受者中采取必要的保护措施。
