PNI、LMR、MELD对肝移植术后早期肺部感染的预测价值
Predictive values of PNI,LMR and MELD for early lung infection after liver transplantation
杨凯 1侯丁聪 2段少先 2毕怡 2谢炎 3张骊 3蒋文涛3
作者信息
- 1. 天津医科大学一中心临床学院(邮编 300192)
- 2. 天津医科大学一中心临床学院(邮编 300192);天津市第一中心医院肝移植科;天津市肝癌分子诊断与治疗重点实验室
- 3. 天津市第一中心医院肝移植科;天津市肝癌分子诊断与治疗重点实验室
- 折叠
摘要
目的 探讨原位肝移植患者术后早期发生肺部感染的相关危险因素,并构建肝移植术后早期肺部感染的预测模型.方法 回顾性分析首次行原位肝移植的269例患者的临床资料,根据术后30 d内是否发生肺部感染分为感染组(97例)和未感染组(172例),收集患者术前一般资料、术前实验室检查结果、术中和术后资料.采用多因素Logistic回归分析肺部感染的危险因素,基于多因素分析结果构建预测模型并评估模型预测效能.结果 2组经单因素和多因素Logistic回归分析,术前预后营养指数(PNI)≤41.70(OR=1.972,95%CI:1.047～3.714,P=0.036)、淋巴细胞计数与单核细胞计数比值(LMR)≤1.52(OR=2.020,95%CI:1.102～3.705,P=0.023)、终末期肝病模型(MELD)＞10.72(OR=1.985,95%CI:1.103～3.573,P=0.022)、手术时间＞448 min(OR=2.676,95%CI:1.515～4.727,P=0.001)、重症监护病房(ICU)住院时间＞4.0 d(OR=2.623,95%CI:1.335～5.154,P=0.005)是肝移植术后早期肺部感染的独立危险因素.基于多因素分析结果构建的预测模型的受试者工作特征曲线下面积为0.768,敏感度为80.41%,特异度为60.47%.结论 基于PNI、LMR、MELD、手术时间、ICU住院时间构建的预测模型可有效预测肝移植术后早期肺部感染的发生.
Abstract
Objective To explore risk factors of early lung infection after liver transplantation and to construct a prediction model of early lung infection after liver transplantation.Methods The clinical data of 269 patients who underwent orthotopic liver transplantation for the first time were retrospectively analyzed.Patients were divided into the infected group(n=97)and the non-infected group(n=172)according to whether pulmonary infection occurred within 30 days after operation.The preoperative general data,preoperative laboratory examination results,intraoperative and postoperative data of the patients were collected.Multivariate Logistic regression analysis were used to screen risk factors of pulmonary infection.Based on the results of multivariate analysis,the prediction model was constructed and the prediction efficiency of the model was evaluated.Results Univariate and multivariate Logistic regression analysis showed that preoperative PNI≤41.70(OR=1.972,95%CI:1.047-3.714,P=0.036),LMR≤1.52(OR=2.020,95%CI:1.102-3.705,P=0.023),MELD score＞10.72(OR=1.985,95%CI:1.103-3.573,P=0.022),operative time＞448.00 min(OR=2.676,95%CI:1.515-4.727,P=0.001)and intensive care unit(ICU)hospitalization time＞4.0 days(OR=2.623,95%CI:1.335-5.154,P=0.005)were independent risk factors for early pulmonary infection after liver transplantation.The ROC area under the curve(AUC)of the prediction model based on the results of multivariate Logistic regression analysis was 0.768,the sensitivity was 80.41%and the specificity was 60.47%.Conclusion The prediction model based on PNI,LMR,MELD score,operation time and ICU hospitalization time can effectively predict the occurrence of early pulmonary infection after liver transplantation.
关键词
肝移植/手术后并发症/预后营养指数/淋巴细胞单核细胞比值/终末期肝病模型/预测模型Key words
liver transplantation/postoperative complications/prognostic nutritional index/lymphocyte-monocyte ratio/model for end-stage liver disease/predictive model引用本文复制引用
基金项目
国家自然科学基金青年项目(82202399)
细胞生态海河实验室创新基金(22HHXBJC00001)
出版年
2024
NETL
NSTL
万方数据