Risk factors for pulmonary infection in patients esophageal cancer and establishment of prediction model
OBJECTIVE To explore the distribution of pathogens and risk factors for pulmonary infection in the pa-tients with esophageal cancer,establish the risk prediction model and evaluate the predictive value.METHODS To-tally 169 patients with esophageal cancer who received surgical procedures in Nanyang Second People's Hospital from May 2018 to Dec 2022 were recruited as the research subjects,52 of whom were complicated with pulmonary infection and were assigned as the infection group,117 were not complicated with pulmonary infection and were assigned as the no infection group.The distribution of pathogens isolated from the esophageal cancer patients com-plicated with pulmonary infection was statistically analyzed.Multivariate logistic regression analysis was per-formed for the risk factors,the risk prediction model was established,and the predictive value of the model was e-valuated by means of receiver operating characteristic(ROC)curves and calibration curves.RESULTS Totally 61 strains of pathogens were isolated from 52 patients complicated with pulmonary infection,37(60.66％)of which were gram-negative bacteria.The result of multivariate logistic regression analysis showed that upper/middle site of tumor,smoking history,complication with diabetes mellitus and high levels of peripheral blood TLR4 and NF-κB mRNA were associated with the postoperative pulmonary infection in the esophageal cancer patients(P＜0.05).The result of Hosmer-Lemeshow test of goodness of fit indicated that the model has favorable fitting accu-racy(x2=6.214,P=0.623),the calibration curves showed that the model had favorable capabilities of differenti-ation,calibration and prediction.The result of ROC curve analysis indicated that the area under curve(AUC)was 0.880(95％CI 0.822-0.938),the sensitivity of the model was 75％in diagnosis,with the specificity 87.18％.CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the esophageal cancer patients with postoperative pulmonary infection,and the incidence of the infection is associated with the upper/middle site of tumor,smoking history,complication with diabetes mellitus and change of TLR4/NF-κB signaling pathways.The risk prediction model established based on the factors has high accuracy and differentiation degree.
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