Construction of risk prediction model for postoperative infection of thoracolumbar vertebral fracture combined with spinal cord injury
于超 1刘建生 1张磊 1孟小娜 1魏巍 1杨艳 1姚立军2
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作者信息
1. 唐山市第二医院脊柱科 河北 唐山 063000
2. 唐山市第二医院急诊科 河北 唐山 063000
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摘要
目的 分析影响胸腰椎骨折合并脊髓损伤术后感染的因素,据此构建风险预测模型.方法 采用回顾性分析进行研究,研究对象选自2022年1月至2022年12月在唐山市第二医院行手术治疗的148例胸腰椎骨折合并脊髓损伤患者.将其按照术后住院期间是否感染分为感染组(n=67)和非感染组(n=81).收集患者的临床、手术及实验室资料,采用Logistic回归分析胸腰椎骨折合并脊髓损伤术后感染的影响因素,据此构建风险预测模型,以受试者工作特征(ROC)曲线分析风险模型对于胸腰段脊柱骨折合并脊髓损伤患者术后感染的预测价值.结果 单因素结果显示,感染组和非感染组患者年龄[(67.23±5.26)岁vs.(60.21±4.25)岁]、糖尿病占比(62.69％vs.35.80％)、合并慢性阻塞性肺疾病(COPD)占比(73.13％vs.40.74％)、美国脊髓损伤协会损伤量表(ASIA)分级A级人数占比(47.76％vs.14.81％)、ASIA分级D级人数占比(5.97％vs.38.27％)、留置导尿占比(53.73％vs.27.16％)、间歇导尿占比(46.27％vs.73.84％)、血清 C 反应蛋白(CRP)[(57.85±9.72)mg/L vs.(44.84±10.22)mg/L]、降钙素原[(0.37±0.08)μg/L vs.(0.23±0.07)μg/L]比较,差异均有统计学意义(P＜0.05).多因素Logistic回归分析结果显示,糖尿病、合并COPD、留置导尿、高龄、血清CRP、降钙素原水平升高是胸腰椎骨折合并脊髓损伤术后感染的独立危险因素(P＜0.05),其中ASIA分级高为胸腰椎骨折合并脊髓损伤术后感染的保护因素(P＜0.05).胸腰椎骨折合并脊髓损伤术后感染的风险预测模型ROC曲线下面积为0.982(95％CI:0.956～1.000),敏感度为95.522％、特异度为97.531％.结论 胸腰椎骨折合并脊髓损伤术后感染与糖尿病、合并COPD、留置导尿、高龄、血清CRP、降钙素原水平升高等多种因素相关,其中ASIA分级高为其保护因素,同时据此风险因素构建的风险预测模型具有较好的预测效能.
Abstract
Objective To analyze the factors affecting postoperative infection of thoracolumbar fracture combined with spinal cord injury,and to construct a risk prediction model.Methods A retrospective analysis was conducted.The study subjects were selected from 148 patients with thoracolumbar fracture combined with spinal cord injury who underwent surgical treatment in the Second Hospital of Tangshan from January 2022 to December 2022.They were divided into the infection group(n=67)and the non-infection group(n=81)according to whether they had infection during postoperative hospitalization.Logistic regression was used to analyze the influencing factors of postoperative infection in pa-tients with thoracolumbar fracture combined with spinal cord injury,and the risk prediction model was constructed accordingly.The receiver oper-ating characteristic(ROC)curve was used to analyze the predictive value of the risk model for postoperative infection in patients with thoracolum-bar fracture combined with spinal cord injury.Results Univariate analysis showed that there were statistically significant differences in age[(67.23±5.26)years vs.(60.21±4.25)years],the proportion of diabetes mellitus(62.69％vs.35.80％),the proportion of chronic ob-structive pulmonary disease(COPD)(73.13％vs.40.74％),and the proportion of American Spinal Cord Injury Association Injury Scale(A-SIA)grade A(47.76％vs.14.81％),ASIA grade D(5.97％vs.38.27％),indwelling catheterization(53.73％vs.27.16％),intermittent catheterization(46.27％vs.73.84％),serum C-reactive protein(CRP)[(57.85±9.72)mg/L vs.(44.84±10.22)mg/L]and procalcito-nin[(0.37±0.08)μg/L vs.(0.23±0.07)μg/L]between the patients in the infection group and the non-infection group(P＜0.05).Multivariate Logistic regression analysis showed that diabetes mellitus,COPD,indwelling catheterization,advanced age,increased serum CRP and procalcitonin levels were independent risk factors for postoperative infection of thoracolumbar fracture combined with spinal cord injury(P＜0.05).High ASIA grade was a protective factor for postoperative infection of thoracolumbar fracture combined with spinal cord injury(P＜0.05).The area under the ROC curve of the risk prediction model for postoperative infection of thoracolumbar fracture combined with spinal cord injury was 0.982(95％CI:0.956-1.000),with a sensitivity of 95.522％and a specificity of 97.531％.Conclusion Infection after thoracolumbar fracture combined with spinal cord injury is associated with diabetes mellitus,COPD,indwelling catheterization,advanced age,elevated serum CRP and procalcitonin levels and other factors,among which high ASIA grade is a protective factor,and the risk prediction model constructed based on these risk factors has good predictive efficacy.
关键词
胸腰椎骨折/脊髓损伤/术后感染/危险因素/预测模型
Key words
Thoracolumbar fracture/Spinal cord injury/Postoperative infection/Risk factors/Prediction model
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