Establish a nosocomial infection risk prediction model for elderly patients with AMI after PCI and evaluate its efficacy based on nomogram
Objective To investigate the risk factors of nosocomial infection in elderly patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI),and to construct and verify a prediction model based on the nomogram.Methods Clinical data of 228 elderly patients with AMI who underwent PCI in our hospital from March 2021 to March 2023 were collected.Patients were divided into the infected group(n=32)and the uninfected group(n=196)according to whether there was nosocomial infection after PCI.The difference in clinical indicators between the two groups was compared,the influencing factors were analyzed by binary logistic regression,the prediction model was constructed by nomogram,and the predictive value of the model was evaluated by receiver operator characteristic curve(ROC).Results In this study,32 patients with postoperative nosocomial infection occurred,the infection rate was 14％.A total of 35 pathogenic bacteria were cultured,of which 9 were gram-positive,23 were gram-negative,and 3 were fungi.Logistic regression analysis showed that age ≥70 years old,tracheal intubation,mechanical ventilation,indignant catheter,no antibiotics used,and cardiac function grade ≥ Ⅲ were the risk factors for nosocomial infection in elderly patients with AMI after PCI(P＜0.05).ROC analysis results showed that the curve AUC of age,tracheal intubation,mechanical ventilation,indignant catheter,use of antibiotics,cardiac function grade,and prediction model were 0.652,0.600,0.582,0.662,0.619,0.606 and 0.832,respectively.The sensitivity was 65.6％,85.7％,91.3％,73.0％,43.8％,65.6％,82.1％,and the specificity was 64.8％,34.4％,25.0％,59.4％,80.1％,55.6％,68.7％,respectively.Internal verification showed that the bias-corrected prediction curve is consistent with the ideal line,and the decision curve showed that the threshold probability of the model ranges from 0.01 to 0.96,and its net return rate is＞0.Conclusion The main risk factors for nosocomial infection in elderly patients with AMI after PCI include age ≥70,tracheal intubation,mechanical ventilation,independent catheter,no use of antibiotics,and cardiac function grade ≥ Ⅲ.The prediction model based on this nomogram has high sensitivity and specificity.
Myocardial infarctionHospital infectionsRoot cause analysesNomographPercutaneous coronary interventionPrediction model
万方数据
维普
