老年髋部骨折术后患者肺部感染预测模型的构建及验证

目的 探讨老年髋部骨折术后患者肺部感染的影响因素,并构建风险预测模型。方法 选择2017年5月—2019年5月在上海市某三级甲等医院行手术治疗的老年髋部骨折患者1 008例,按照术后是否发生肺部感染分为肺部感染组（n=87）和非肺部感染组（n=921）,并对两组资料进行对比,利用单因素分析和Logistic回归分析探讨老年髋部骨折术后患者肺部感染的影响因素,建立风险预测模型并绘制列线图,采用ROC曲线下面积及Hosmer-Lemeshow检验评估模型预测效果。结果 年龄、骨折至手术时间、吸烟史、美国麻醉医师协会（American Society of Anesthesiologists,ASA）分级、是否合并COPD、是否合并低蛋白血症、红细胞分布宽度（red cell distribution width,RDW）、机械通气时间、是否入住ICU是老年髋部骨折术后患者肺部感染的影响因素,预测模型验证结果显示,建模组术后发生肺部感染风险的ROC曲线下面积为0.891（P<0.001）,验证组术后发生肺部感染风险的ROC曲线下面积为0.881（P<0.001）。建模组和验证组Hosmer-Lemeshow检验的P值分别为0.726和0.497。结论 年龄>73岁、骨折至手术时间>4 d、合并COPD等可增加老年髋部骨折术后患者肺部感染的发生率,构建的模型可以有效预测老年髋部骨折术后患者肺部感染的发生。

Construction and validation of a prediction model for pulmonary infection in elderly patients with hip fracture after surgery

Objective This study was to investigate the risk factors of pulmonary infection in elderly patients with hip fracture postoperatively,and to establish a predictive model.Methods A total of 1 008 elderly hip fracture patients who underwent surgical treatment in a tertiary hospital in Shanghai from May 2017 to May 2019 were selected and divided into a pulmonary infection group（n=87） or a non-pulmonary infection group（n=921）,according to their pulmonary infections after surgery. The clinical data was compared. Univariate analysis and multivariate Logistic regression were used to analyze the independent risk factors of postoperative pulmonary infection in elderly patients with hip fracture. A risk prediction model was established and nomogram was drawn. The area under ROC curve and Hosmer-Lemeshow test were used to evaluate the predictive effect of the model.Results The multivariate regression analysis showed that age,time from fracture to surgery,smoking,ASA,COPD,hypoproteinemia,RDW,mechanical ventilation time,stay in ICU were independent risk factors of pulmonary infection postoperatively in elderly patients. The AUC of modeling patients was 0.891 and 0.881 in the verification sample. As to the Hosmer-Lemeshow Test,the P value of modeling patients is 0.726 and 0.497 in verification（P>0.05）.Conclusion Overall,this study uncovers different clinical features that can increase the risks of postoperative pulmonary infection in elderly patients with hip fracture,such as age >73,long time from fracture to surgery（day）>4 d and COPD. This model can effectively predict the occurrence of postoperative pulmonary infection.