实用医学杂志2025，Vol.41Issue(5)：683-690,8.DOI:10.3969/j.issn.1006-5725.2025.05.010
儿童先天性心脏病术后抗生素相关性腹泻预测模型的构建与验证
Construction and validation of a predictive model for antibiotic-associated diarrhea after surgery in chil-dren with congenital heart disease
摘要
Abstract
Objective To investigate the influencing factors of antibiotic-associated diarrhea(AAD)following congenital heart disease(CHD)surgery in pediatric patients,develop a nomogram-based predictive model,and validate its efficacy.Methods A retrospective analysis was conducted on the clinical data of pediatric patients who underwent CHD surgery in the Pediatric Intensive Care Unit(PICU)of a tertiary hospital in Guang-dong Province from July 2022 to July 2024.Patients were categorized into an AAD group and a non-AAD group.Univariate and multivariate logistic regression analyses were performed to identify risk factors for AAD occurrence following CHD surgery.A risk prediction model was developed,and a nomogram was constructed.The predictive performance of the model was evaluated using the Receiver Operating Characteristic(ROC)curve to calculate the area under the curve(AUC),the Hosmer-Lemeshow goodness-of-fit test,calibration curves,and clinical decision curve analysis.External validation of the model was conducted using data from patients in the Surgical Intensive Care Unit(SICU).Results The incidence of AAD following CHD surgery was 48.52%(229 out of 472 cases).Risk factors for AAD included the combined use of antibiotics,mechanical ventilation,elevated C-reactive protein levels,prolonged surgical duration,and extended antibiotic usage time(all with OR>1,P<0.05).Conversely,probiotic administration was identified as a protective factor(OR<1,P<0.05).The predictive model demon-strated excellent discrimination,as evidenced by the ROC curve areas:0.922(95%CI:0.894～0.951)in the modeling group,0.886(95%CI:0.838～0.915)in the internal validation group,and 0.862(95%CI:0.784～0.941)in the external validation group.Additionally,the model exhibited satisfactory calibration,as indicated by the Hosmer-Lemeshow test results:χ2=7.96,P=0.538 in the modeling group;χ2=4.24,P=0.895 in the inter-nal validation group;and χ2=9.923,P=0.270 in the external validation group.Furthermore,the model provided significant clinical utility.Conclusions Combined antibiotic use,duration of antibiotic therapy,mechanical ventilation,surgical duration,C-reactive protein(CRP)levels,and probiotic administration are key factors influ-encing the occurrence of AAD.The risk prediction model developed based on these variables demonstrates robust predictive performance and can serve as a valuable reference for the development and implementation of preventive and therapeutic strategies in clinical practice.关键词
儿童/先心病/抗生素相关性腹泻/影响因素/预测模型/列线图Key words
children/congenital heart disease/antibiotic-associated diarrhea/risk factors/pre-dictive model/nomogram分类
临床医学引用本文复制引用
刘冬丽,全梓林,钟灵秀,陈琦琦,蔡文巧,庄森培,魏莹,潘惠仪,林雅文..儿童先天性心脏病术后抗生素相关性腹泻预测模型的构建与验证[J].实用医学杂志,2025,41(5):683-690,8.基金项目
广东省医学科研基金项目(编号:A2024702) （编号:A2024702）
