摘要
目的 探讨老年创伤性四肢骨折患者术后切口感染的影响因素,并构建列线图模型.方法 选取2021年5月—2023年9月成都医学院第一附属医院收治的360例接受手术治疗的老年创伤性四肢骨折患者作为研究对象,采用随机数字表法分为建模组252例与验证组108例.采用LASSO回归、logistic回归分析术后切口感染的影响因素,根据影响因素构建列线图,通过ROC曲线、校准曲线评估风险预测模型的预测性能及效果.结果 27个研究变量纳入LASSO回归模型中进行筛选,基于最小值与标准化构建2个模型.模型1共纳入12个变量,分别为体质量指数(BMI)、使用钢板、合并糖尿病、引流管放置时间、切口类型、手术时间、切口长度、术后3天外周血C反应蛋白与白蛋白比值(CAR)、血清降钙素原(PCT)/白蛋白(ALB)、白细胞介素-6(IL-6)、中性粒细胞与淋巴细胞比值(NLR)及血清红细胞沉降率(ESR);模型2共纳入7个变量,分别为合并糖尿病、引流管放置时间及术后3天外周血CAR、PCT/ALB、IL-6、NLR及ESR.以术后切口是否发生感染为因变量,模型1与模型2中经LASSO回归筛选出的变量作为自变量,分别构建logistic回归分析模型,模型1结果显示:BMI≥28 kg/m2、合并糖尿病、切口类型Ⅲ型、手术时间、切口长度、使用钢板、引流管放置时间≥6 d及术后3天外周血CAR、PCT/ALB、IL-6、NLR、ESR均为老年创伤性四肢骨折患者术后切口感染的独立危险因素(P＜0.05);模型2结果显示:合并糖尿病、引流管放置时间≥6 d及术后3天外周血CAR、PCT/ALB、IL-6、NLR及ESR均为老年创伤性四肢骨折患者术后切口感染的独立危险因素(P＜0.05).模型1在建模组与验证组中的 ROC 曲线下面积分别为 0.949(95％CI:0.898～1.000)、0.981(95％CI:0.956～1.000),且模型1在建模组与验证组中的Hosmer-Lemeshow检验结果显示该模型未偏离完美拟合,校准曲线一致性良好.模型2在建模组与验证组中的ROC曲线下面积分别为0.882(95％CI:0.787～0.977)、0.921(95％CI:0.843～1.000),且模型2在建模组与验证组中的Hosmer-Lemeshow检验显示该模型偏离完美拟合,校准曲线一致性不佳.结论 BMI、合并糖尿病、切口类型、手术时间、切口长度、使用钢板、引流管放置时间及术后3天外周血CAR、PCT/ALB、IL-6、NLR、ESR是引发老年创伤性四肢骨折患者术后切口感染的影响因素.
Abstract
Objective To explore the influencing factors of incision infection in elderly patients with traumatic limb fracture after surgery,and to construct a nomographic model.Methods A total of 360 elderly patients with traumatic limb fracture who re-ceived surgical treatment in the First Affiliated Hospital of Chengdu Medical College from May 2021 to September 2023 were selected as the study subjects and divided into the modeling group(n=252)and the verification group(n=108)by the computer random number table.LASSO regression and logistic regression were used to analyze the influencing factors of postoperative incision infection,and col-umn line diagrams were constructed according to the influencing factors,and the predictive performance and effect of the risk prediction model were evaluated by ROC curve and calibration curve.Results Twenty-seven research variables were included in the LASSO re-gression model for screening,and two models were constructed based on minimum values and standardization.Model 1 included 12 var-iables,including body mass index(BMI),use of steel plate,diabetes,drainage tube placement time,incision type,operation time,incision length,the ratio of peripheral blood C-reactive protein to albumin(CAR),serum procalcitonin(PCT)/albumin(ALB),in-terleukin-6(IL-6),neutrophil to lymphocyte ratio(NLR),and serum erythrocyte sedimentation rate(ESR)three days after opera-tion.Seven variables were included in model 2,including diabetes,drainage tube placement time,and peripheral blood CAR,PCT/ALB,IL-6,NLR,ESR 3 days after surgery.The logistic regression analysis models were constructed with the dependent variable of whether the incision infection occurred after surgery,and the variables screened by LASSO regression in model 1 and model 2 as inde-pendent variables.The results of model 1 showed that BMI ≥28 kg/m2,combined with diabetes,incision type Ⅲ,operation time,in-cision length,use of steel plate,placement time of drainage tube≥6 days,and peripheral blood CAR,PCT/ALB,IL-6,NLR,ESR 3 days after surgery were independent risk factors for postoperative incision infection in elderly patients with traumatic limb fracture(P＜0.05).The results of model 2 showed that the combination of diabetes,the placement time of drainage tube ≥ 6 days and the pe-ripheral blood CAR,PCT/ALB,IL-6,NLR,ESR 3 days after operation were independent risk factors for postoperative incision infec-tion in elderly patients with traumatic limb fracture(P＜0.05).The area under the ROC curve of Model 1 in the modeling and vali-dation groups was respectively 0.949(95％CI:0.898-1.000)and 0.981(95％CI:0.956-1.000),respectively.The results of the Hosmer Lemeshow test for Model 1 in the modeling and validation groups showed that the model did not deviate from a perfect fit,and the consistency of the calibration curve was good.The area under the ROC curve of Model 2 in the modeling and validation groups was respectively 0.882(95％CI:0.787-0.977)and 0.921(95％CI:0.843-1.000),respectively.Furthermore,the Hosmer Lemeshow test of Model 2 in the modeling and validation groups showed that the model deviated from a perfect fit and the consistency of the calibration curve was poor.Conclusion BMI,combined diabetes,incision type,operation time,incision length,use of steel plate,placement time of drainage tube,CAR,PCT/ALB,IL-6,NLR and ESR of peripheral blood 3 days after operation are the influ-encing factors of postoperative incision infection in elderly patients with traumatic limb fracture.
基金项目
2022年校级教育教学项目立项清单(JG2022025)
2021年成都医学院四川应用心理学研究中心立项(CSXL-212A22)
2021年医院发展研究中心立项项目(YYFZ21006)
维普
万方数据