Establishment of prediction model and risk factors for secondary descending necrotizing mediastinitis in patients with multiple space infection of head and neck region
OBJECTIVE To explore the risk factors for secondary descending necrotizing mediastinitis(DNM)in the patients with multiple space infection of head and neck region and establish the prediction model.METHODS A to-tal of 331 patients with multiple space infection of head and neck region who were treated in Guizhou Provincial People's Hospital from Oct 2018 to Oct 2022 were recruited as the research subjects and were divided into the sec-ondary group with 40 cases and the non-secondary group with 291 cases according to the status of secondary DNM.The prevalence of DNM and distribution of pathogens were observed,logistic regression analysis was performed for the risk factors for the DNM,the prediction model was established,and the value of the model in prediction of the DNM was analyzed.RESULTS Among the 331 patients with multiple space infection of head and neck region,40 had DNM,with the incidence of secondary DNM 12.08％.Totally 40 strains of pathogens were isolated from the 40 patients of the secondary group,27(67.50％)of which were gram-positive bacteria.The result of multiva-riate logistic analysis showed that diabetes mellitus,pneumatosis,parapharyngeal space and high level of C-reac-tive protein(CRP)were the risk factors for the secondary DNM in the patients with multiple space infection of head and neck region(P＜0.05).The established regression equation model was as follows:Logit(P)=-30.879+complication with diabetes mellitus × 2.193+CRP level × 0.236+pneumatosis × 4.387+parapharyngeal space × 3.211.The result of receiver operating characteristic(ROC)curve analysis showed that when Logit(P)was more than 0.082,the area under curve(AUC)was 0.995,with the sensitivity 97.50％for diagnosis,the specificity 94.85％.CONCLUSION The incidence of DNM is high among the patients with multiple space infection of head and neck region,and there are a variety of risk factors.The gram-positive bacteria are dominant.The established model has high value in prediction of DNM,and it is necessary for the hospital to formulate prevention measures so as to prevent the DNM.
Head and neck regionMultiple space infectionMediastinitisRisk factorReceiver operating charac-teristic curveNomogramPathogen
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