呼吸科住院患者抗生素药物相关腹泻风险预测模型的构建及验证

doi:10.3761/j.issn.0254-1769.2021.01.004

摘要/Abstract

摘要：

目的通过分析呼吸科住院患者抗生素药物相关腹泻的危险因素,建立并验证呼吸科住院患者抗生素药物相关腹泻风险的列线图模型。方法纳入2019年1月—9月于北京市某三级甲等医院呼吸科病房住院使用抗生素治疗的患者291例并收集临床资料。应用Logistic回归模型分析呼吸科住院患者抗生素药物相关腹泻的独立危险因素。应用R软件构建预测呼吸科住院患者抗生素药物相关腹泻风险的列线图模型,并进行验证。结果 Logistic回归分析显示,大便潜血[OR=4.517,95%CI（1.440~14.163）]、体重指数[OR=0.834,95%CI（0.735~0.947）]、血红蛋白浓度[OR=0.970,95%CI（0.946~0.994）]、院前使用抗生素[OR=2.957,95%CI（1.076~8.130）]及使用抗生素种类[OR=2.148,95%CI（1.146~4.026）]是呼吸科住院患者抗生素药物相关腹泻的独立危险因素（P<0.05）。对列线图模型进行验证,ROC曲线显示该模型预测呼吸科住院患者抗生素药物相关腹泻的风险曲线下面积为0.779;校准曲线为斜率接近于1的直线,Hosmer-Lemeshow拟合优度检验（ χ²=1.413,P=0.994）均显示该模型能够较准确地预测呼吸科住院患者抗生素药物相关腹泻的风险。结论该研究基于大便潜血、院前使用抗生素、体重指数、血红蛋白浓度、使用抗生素种类数这5项抗生素药物相关腹泻发生的独立危险因素,构建的列线图模型具有良好的区分度与准确度,可为临床个体化预测抗生素药物相关腹泻发生风险提供参考。

关键词: 呼吸道疾病, 抗菌药, 抗生素药物相关腹泻, 列线图, 护理

Abstract:

Objective To determine risk factors of antibiotic associated diarrhea in patients with respiratory diseases,and develop a nomogram model to predict these risks. Methods A total of 291 patients who underwent antibiotics treatment were recruited from January,20l9 and September,2019 at respiratory department in a Level A tertiary hospital in Beijing. Multivariate logistic regression was conducted to identify independent risk factors of antibiotic associated diarrhea in inpatients with respiratory diseases. A nomogram was developed by R software and validated to predict the risk of antibiotic associated diarrhea. Results Multivariate logistic regression analysis revealed that fecal occult blood test[OR=4.517,95%CI（1.440~14.163）],BMI[OR=0.834,95%CI（0.735~0.947）], hemoglobin level[OR=0.970,95%CI（0.946~0.994）],the use of antibiotics before hospitalization[OR=2.957,95%CI（1.076~8.130）] and types of antibiotic[OR=2.148,95%CI（1.146~4.026）] were independent risk factors of antibiotic associated diarrhea in patients with respiratory diseases（P<0.05）. For validation of the nomogram,ROC curve revealed that the model predicting antibiotic associated diarrhea in patients with respiratory diseases was the area under the curve of 0.779,the slope of the calibration plot was close to 1 and the model passed Hosmer-Lemeshow goodness of fit test（ χ²=1.413,P=0.994）,which demonstrated that the model was of good accuracy. Conclusion The nomogram predicting antibiotic associated diarrhea in patients with respiratory diseases was constructed based on fecal occult blood test,BMI,hemoglobin level,the use of antibiotics before hospitalized and types of antibiotic,which has good discrimination and accuracy. It can provide scientific guidance for clinical individualized prevention of antibiotic associated diarrhea.

Key words: Respiratory Tract Diseases, Anti-Bacterial Agents, Antibiotic Associated Diarrhea, Nomogram, Nursing Care

赵东芳,陈晨,苏春燕,张会芝,刘然,侯月梅,孙雪. 呼吸科住院患者抗生素药物相关腹泻风险预测模型的构建及验证[J]. 中华护理杂志, 2021, 56(1): 28-32.

ZHAO Dongfang,CHEN Chen,SU Chunyan,ZHANG Huizhi,LIU Ran,HOU Yuemei,SUN Xue. Establishment of a nomogram model for risks of antibiotic associated diarrhea in hospitalized patients with respiratory diseases[J]. Chinese Journal of Nursing, 2021, 56(1): 28-32.

图/表 6

表1 两组临床资料比较

Tab.1 Comparison of clinical data between the two groups

表2 抗生素药物相关腹泻的Logistic回归分析(n=291)

Multivariate logistic regression analysis of antibiotic associated diarrhea (n=291)

图1 预测呼吸科患者抗生素药物相关腹泻的列线图模型

Fig 1 Nomogram model for predicting antibiotic associated diarrhea in respiratory patients

图2 列线图模型预测呼吸科患者抗生素药物相关腹泻风险的ROC曲线

Fig 2 ROC curve of nomogram model for predicting antibiotic associated diarrhea risk in respiratory patients

图3 预测呼吸科患者抗生素药物相关腹泻风险列线图模型的校准曲线

Fig 3 Calibration curve of nomogram model for predicting antibiotic associated diarrhea risk in respiratory patients

图3 预测呼吸科患者抗生素药物相关腹泻风险列线图模型的校准曲线

Fig 3 Calibration curve of nomogram model for predicting antibiotic associated diarrhea risk in respiratory patients

参考文献 13

[1]	Silverman MA, Konnikova L, Gerber JS. Impact of antibiotics on necrotizing enterocolitis and antibiotic-associated diarrhea[J]. Gastroenterol Clin North Am, 2017,46(1):61-76. DOI URL PMID
[2]	Tian CF, Su BY, Li YJ, et al. Management of antibiotic-associated pseudomembranous colitis in non-hospitalized and hospitalized patients[J]. Pak J Pharm Sci, 2016,29(5 Suppl):1805-1810. URL PMID
[3]	陶立元, 张华, 赵一鸣. 列线图的制作要点及其应用[J]. 中华儿科杂志, 2017,55(5):323.
	Tao LY, Zhang H, Zhao YM. The key points of making a nomograph and its application[J]. Chin J Pedia, 2017,55(5):323.
[4]	卫生部. 医院感染诊断标准(试行)[J]. 中华医学杂志, 2001,81(5):314-320.
	Minister of Health. Diagnostic criteria for nosocomial infection(Trial)[J]. Natl Med J China, 2001,81(5):314-320.
[5]	Elseviers MM, Van Camp Y, Nayaert S, et al. Prevalence and management of antibiotic associated diarrhea in general hospitals[J]. BMC Infect Dis, 2015,15:129. DOI URL PMID
[6]	Ma H, Zhang L, Zhang Y, et al. Combined administration of antibiotics increases the incidence of antibiotic-associated diarrhea in critically ill patients[J]. Infect Drug Resist, 2019,12:1047-1054. DOI URL PMID
	Ma H, Zhang L, Zhang Y, et al. Combined administration of antibiotics increases the incidence of antibiotic-associated diarrhea in critically ill patients[J]. Infect Drug Resist, 2019,12:1047-1054. DOI URL PMID
[7]	孙莉萍, 王芳, 谢秀华. 重症细菌性肺炎患者抗生素相关性腹泻的发生情况及危险因素探究[J]. 中国医学前沿杂志(电子版), 2018,10(12):126-129.
	孙莉萍, 王芳, 谢秀华. 重症细菌性肺炎患者抗生素相关性腹泻的发生情况及危险因素探究[J]. 中国医学前沿杂志(电子版), 2018,10(12):126-129.
	Sun LP, Wang F, Xie XH. Study on the occurrence and risk factors of antibiotic associated diarrhea in patients with severe bacterial pneumonia[J]. Chin J the Frontiers of Med Sci(Electronic Version), 2018,10(12):126-129.
	Sun LP, Wang F, Xie XH. Study on the occurrence and risk factors of antibiotic associated diarrhea in patients with severe bacterial pneumonia[J]. Chin J the Frontiers of Med Sci(Electronic Version), 2018,10(12):126-129.
[8]	金利民, 沈宇泓, 曹晨曦, 等. 恶性肿瘤患者艰难梭菌感染相关性腹泻的临床特征分析[J]. 中华全科医学, 2018,16(5):820-822,834.
	金利民, 沈宇泓, 曹晨曦, 等. 恶性肿瘤患者艰难梭菌感染相关性腹泻的临床特征分析[J]. 中华全科医学, 2018,16(5):820-822,834.
	Jin LM, Shen YH, Cao CX, et al. Clinical characteristics for clostridium difficile-associated diarrhea among malignant tumor patients[J]. Chin J Gener Pract, 2018,16(5):820-822,834.
	Jin LM, Shen YH, Cao CX, et al. Clinical characteristics for clostridium difficile-associated diarrhea among malignant tumor patients[J]. Chin J Gener Pract, 2018,16(5):820-822,834.
[9]	张峥. 细菌性重症肺炎患者抗生素治疗所致腹泻发生的相关因素分析[J]. 中国处方药, 2016,14(9):113-114.
	张峥. 细菌性重症肺炎患者抗生素治疗所致腹泻发生的相关因素分析[J]. 中国处方药, 2016,14(9):113-114.
	Zhang Z. Analysis of the related factors of antibiotic associated diarrhea in patients with severe bacterial pneumonia[J]. J China Prescription Drug, 2016,14(9):113-114.
	Zhang Z. Analysis of the related factors of antibiotic associated diarrhea in patients with severe bacterial pneumonia[J]. J China Prescription Drug, 2016,14(9):113-114.
[10]	高素颖, 颜应琳, 刘东亮, 等. 老年人体质指数与代谢指标及心脑血管疾病的关系[J]. 中国老年学杂志, 2017,37(5):1108-1111.
	高素颖, 颜应琳, 刘东亮, 等. 老年人体质指数与代谢指标及心脑血管疾病的关系[J]. 中国老年学杂志, 2017,37(5):1108-1111.
	Gao SY, Yan YL, Liu DL, et al. Relationship between body mass index,metabolic index and cardiovascular and cerebrovascular diseases in the elderly[J]. Chin J Gerontol, 2017,37(5):1108-1111.
	Gao SY, Yan YL, Liu DL, et al. Relationship between body mass index,metabolic index and cardiovascular and cerebrovascular diseases in the elderly[J]. Chin J Gerontol, 2017,37(5):1108-1111.
[11]	王树相, 陈鑫磊, 徐超. 个体化预测老年髋部骨折患者术后谵妄风险[J]. 中国矫形外科杂志, 2019,27(6):542-548.
	王树相, 陈鑫磊, 徐超. 个体化预测老年髋部骨折患者术后谵妄风险[J]. 中国矫形外科杂志, 2019,27(6):542-548.
	Wang SX, Chen XL, Xu C. Individualized prediction of postoperative delirium in elderly patients with hip fracture[J]. Orthopedic J China, 2019,27(6):542-548.
	Wang SX, Chen XL, Xu C. Individualized prediction of postoperative delirium in elderly patients with hip fracture[J]. Orthopedic J China, 2019,27(6):542-548.
[12]	Choi NY, Kim EH, Baek CH, et al. Development of a nomogram for predicting the probability of postoperative delirium in patients undergoing free flap reconstruction for head and neck cancer[J]. Eur J Surg Oncol, 2017,43(4):683-688. DOI URL PMID
	Choi NY, Kim EH, Baek CH, et al. Development of a nomogram for predicting the probability of postoperative delirium in patients undergoing free flap reconstruction for head and neck cancer[J]. Eur J Surg Oncol, 2017,43(4):683-688. DOI URL PMID
[13]	王艺璇, 李惠萍, 丁晓彤, 等. 乳腺癌术后淋巴水肿风险预测模型的研究进展[J]. 中华护理杂志, 2018,53(6):740-743.
	王艺璇, 李惠萍, 丁晓彤, 等. 乳腺癌术后淋巴水肿风险预测模型的研究进展[J]. 中华护理杂志, 2018,53(6):740-743.
	Wang YX, Li HP, Ding XT, et al. Research progress on risk prediction model of lymphedema after breast neoplasms surgery[J]. Chin J Nurs, 2018,53(6):740-743.
	Wang YX, Li HP, Ding XT, et al. Research progress on risk prediction model of lymphedema after breast neoplasms surgery[J]. Chin J Nurs, 2018,53(6):740-743.

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