基于病情观察的胃癌术后腹腔感染早期预警评分表的构建

目的构建基于病情观察的简易有效、科学实用的胃癌术后腹腔感染早期预警评分表,为识别高危人群及预见性干预提供依据。方法回顾性纳入2015年1月—2017年6月在我院行胃癌根治术的患者共683例进行统计分析,通过单因素分析、二元Logistic回归筛选出腹腔感染独立危险因素,依据各危险因素β值进行赋分,初步构建风险预测评分模型,通过受试者工作特征(ROC)曲线和Hosmer-Lemeshow检验评价模型效能。根据ROC曲线和Youden指数确定危险因素截断值,形成胃癌术后腹腔感染早期预警评分表,并运用于原始数据以确定腹腔感染风险分级标准。结果683例患者中腹腔感染发生率为9.22%;腹腔感染风险预测评分模型的5个因素分别为术后白细胞≥9.95×109个/L(1分)、最快心率≥98次/min(1分)、最高体温≥37.5℃(3分)、主诉腹痛(3分)、主诉腹胀(4分);经验证模型具有较好预测效能(AUC=0.987,95%CI:0.948~0.999,P<0.0001)和较高的拟合优度(χ2=1.152,P=0.997);评分表风险分级为:11~12分为极高危险组,7~10为高危险组,5~6分为中危险组,0~4分为低危险组。结论本研究构建的胃癌术后腹腔感染早期预警评分表有效、实用,但仍需要多中心、大样本的前瞻性研究对其进行进一步验证。

Establishment of early warning scale for postoperative intra-abdominal infection of gastric cancer

Objective To establish a simple,effective and practical early warning score based on illness observation for intra-abdominal infection(IAI)after gastrectomy in order to provide evidence for identifying and predicting interventions for high-risk patients.Methods A retrospective study was conducted on 683 cases with gastric cancer surgery from January 2015 to June 2017 in a hospital.The risk factors of IAI were screened by univariate analysis and multiple logistic regression analysis.The risk prediction model was constructed according to the beta value of each risk factor in the model.Hosmer-Lemeshow test and the receiver operating characteristic(ROC)curve were used to evaluate the predictive compliance degree and discriminant validity of the model.The cut-off value of risk factors was determined according to ROC curve and Youden index and the classification criteria of IAI risk was determined based on the cut-off value and score.Results IAI rate was 9.22%.A established scoring model of IAI risk were postoperative white blood cell more than 9.95(1 point),heart rate more than 98(1 point),temperature more than 37.5℃(3 points),abdominal pain(3 points),abdominal distension(4 points).The validation indicated that the scoring system had higher predictive value(AUC=0.987,95%CI:0.948-0.999,P<0.0001)and high goodness of fit(χ2=Z.152,P=0.997).The scoring table was further divided into the low risk group(0~4 point),mediate risk group(5~7 point),high risk group(8~12 point).Conclusion The early warning score based on illness observation for IAI after gastrectomy is effective and practical.However,a multicenter,large sample prospective study is needed for further validation.