目的 探讨急性白血病患者化疗后肺部感染的危险因素,并建立预测相关风险的列线图模型.方法 收集2019年12月-2021年12月于该院化疗的急性白血病成人患者的临床资料,统计患者肺部感染发生情况和病原菌分布情况,采用单因素、套索算法(least absolute shrinkage and selection operator,LASSO)回归和多因素logistic回归分析筛选相关危险因素,并建立列线图模型.结果 260例患者发生肺部感染62例,发生率23.8％,病原菌以革兰阴性菌为主.化疗持续时间≥7d、血红蛋白水平低、血小板计数＜30×109/L、白细胞计数低、中性粒细胞计数低和使用糖皮质激素是急性白血病患者化疗后肺部感染的独立危险因素(P＜0.05).模型验证结果显示,C-index为0.815,校准曲线趋近于理想曲线,Hosmer-Lemeshow拟合优度检验显示P=0.577.ROC曲线下面积为0.847(95％C/:0.817～0.878).当阈值概率在5％～99％时,患者净获益值高于另外两条临界曲线,该范围内模型具有临床有效性.结论 急性白血病患者化疗后肺部感染的危险因素较多,基于危险因素建立的列线图模型具有良好的预测能力.
Risk factors of pulmonary infection in patients with acute leukemia after chemotherapy and establishment of a risk nomogram model
Objective To explore the risk factors of pulmonary infection in patients with acute leukemia after chemotherapy,and to establish a nomogram model to predict the related risk.Methods We collected the clinical data about adult patients with acute leukemia treated in the First People's Hospital of Linping District from December 2019 to December 2021.The incidence of pulmonary infection and the distribution of pathogenic bacteria in the patients were counted.The relevant risk factors were screened by univariate analysis,least absolute shrinkage and selection operator(LASSO)regression analysis and multivariate logistic regression analysis,and then a nomogram model was established.Results There were 62 cases of pulmonary infection in 260 patients,with an incidence rate of 23.8％.The main pathogens were Gram-negative bacteria.Chemotherapy duration ≥7 days,low hemoglobin level,platelet count＜30×109/L,low leukocyte count,low neutrophil count and glucocorticoid use were independent risk factors for pulmonary infection in the patients with acute leukemia after chemotherapy(P＜0.05).The model verification results revealed that the C-index was 0.815,and the calibration curve approached the ideal curve.Hosmer-Lemeshow goodness-of-fit test showed that P=0.577.The AUC of ROC curve was 0.847(95％CI:0.817-0.878).When the threshold probability was 5％-99％,the patients'net benefit value was higher than those in the other two critical curves,and the model was clinically effective within this range.Conclusion There are many risk factors leading to pulmonary infection in the patients with acute leukemia after chemotherapy.The nomogram model based on the risk factors has good prediction ability.
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