初次全膝关节置换术后发生假体周围感染的危险因素分析及列线图模型构建
Analysis of risk factors for periprosthetic joint infection after primary total knee arthroplasty and con-struction of a nomogram prediction model
杨少强 1房鹏 1王冬生 1张宇 1袁涛 1赵建宁 1包倪荣1
作者信息
- 1. 南方医科大学第一临床医学院附属南京金陵医院(东部战区总医院)骨科,南京 210002
- 折叠
摘要
目的 探讨初次全膝关节置换术(TKA)后发生假体周围感染(PJI)的危险因素,并构建预测此类患者术后感染风险的列线图模型.方法 回顾性统计2010年1月至2019年12月期间南方医科大学第一临床医学院附属南京金陵医院骨科收治的69例初次TKA后发生PJI患者,将之纳入感染组(n=69);根据入院时间、年龄、性别以1∶3比例匹配同期术后未感染患者,将其纳入非感染组(n=207).收集两组患者的体重指数、麻醉方式、手术时间、术前C反应蛋白、术前白蛋白及合并内科疾病情况等资料,应用单因素和多因素条件logistic回归分析筛选出术后发生PJI的危险因素;利用R软件绘制列线图,并计算一致性指数(C指数),绘制受试者工作特征曲线、校准曲线及临床决策曲线.结果 多因素条件logistic回归分析结果显示:术前白蛋白＜35 g/L(OR=7.166,95％CI:3.427～14.983,P＜0.001)、手术时间＞90min(OR=3.163,95％CI·1.476～6.779,P=0.003)、糖尿病(OR=3.966,95％CI:1.833～8.578,P＜0.001)、风湿性疾病(OR=3.531,95％CI:1.362～9.156,P=0.009)、慢性肺部疾病(OR=4.734,95％CI:1.790～12.521,P=0.002)是初次 TKA 后发生PJI的危险因素.通过R软件构建列线图将模型可视化,列线图的C指数为0.809(95％CI:0.751～0.867),表明模型有良好的预测能力;校正曲线显示列线图与实际观测结果有较好的一致性;决策曲线显示该模型的阈值概率在0.08～0.75时具有较好的临床净获益.结论 术前低白蛋白、手术时间长、糖尿病、风湿性疾病、慢性肺部疾病是初次TKA后发生PJI的危险因素,在此基础上构建的列线图预测模型可以为临床医生预防PJI提供参考.
Abstract
Objective To investigate the risk factors for periprosthetic joint infection(PJI)afterprima-ry total knee arthroplasty(TKA)and construct a nomogram model for prediction of such risks.Methods In this retrospective study,we enrolled 69 patients with PJI after primary TKA(the infection group,n=69)who had been admitted to Department of Orthopedics,Nanjing Jinling Hospital,The First School of Clinical Medicine,Southern Medical University from January 2010 to December 2019.The non-infection group includ-ed the patients of the same kind but without postoperative infection during the same period who were matched according to time of admission,age,and gender in a ratio of 1:3(n=207).The data on body mass index,anesthesia method,operation time,preoperative C-reactive protein,preoperative albumin,and comorbid medi-cal conditions were collected from both groups to screen the risk factors for postoperative development of PJI us-ing univariate and multivariate conditional logistic regression analyses.After a nomogram of the risk factors was plotted using R software,the consistency index(C-index)was calculated.The receiver operating characteristic curve,calibration curve,and clinical decision curve were drawn.Results Multivariate conditional logis-tic regression analysis showed that preoperative albumin＜35 g/L(OR=7.166,95％CI:3.427 to 14.983,P＜0.001),operation time＞90 min(OR=3.163,95％CI:1.476 to 6.779,P=0.003),diabetes melli-tus(OR=3.966,95％CI:1.833 to 8.578,P＜0.001),rheumatic diseases(OR=3.531,95％CI:1.362 to 9.156,P=0.009),and chronic lung diseases(OR=4.734,95％CI:1.790 to 12.521,P=0.002)were risk factors for development of PJI after primary TKA.The nomogram constructed with R software visualized the model.The C-index of the nomogram was 0.809(95％CI:0.751 to 0.867),indicating a good predictive capability of the model.The calibration curves of the model showed that the nomogram was in good a-greement with the actual observations.The decision curves showed that the threshold probabilities of the model ranged from 0.08 to 0.75,providing a good net clinical benefit.Conclusions Preoperative low albumin,prolonged operation time,diabetes,rheumatic diseases,and chronic lung diseases may be the risk factors for PJI after primary TKA.The nomogram prediction model based on these factors can provide a reference for clini-cians to prevent PJI.
关键词
关节成形术,置换,膝/假体相关感染/危险因素/列线图Key words
Arthroplasty,replacement,knee/Prosthesis-related infections/Risk factors/Nomo-grams引用本文复制引用
基金项目
四川省中医药局中医药基础研究课题(2020JC0098)
四川省科技厅科技项目(2021YFS0067)
国家中医康复中心建设项目()
出版年
2024
NETL
NSTL
万方数据