肝胆胰外科杂志2025，Vol.37Issue(5)：313-320,325,9.DOI:10.11952/j.issn.1007-1954.2025.05.005
肝切除术后感染危险因素分析及列线图模型的构建与验证
Risk factors for postoperative infection following hepatectomy and construction and validation of nomogram prediction model
王泽桐 1唐洁 1张起帆 1崔忠林 1杨陈凤麟 1李芷西 1周杰1
作者信息
- 1. 南方医科大学南方医院肝胆外科,广东 广州 510515
- 折叠
摘要
Abstract
Objective To investigate the risk factors for postoperative infection following hepatectomy,to establish nomogram prediction models for postoperative infection,and to compare the predictive efficacy of models constructed with preoperative indicators versus with postoperative indicators.Methods A total of 930 patients,who underwent hepatectomy in Nanfang Hospital of Southern Medical University between Jan.2022 and Aug.2023,were retrospectively analyzed.Patients were categorized into the infection group(n=203)and the non-infection group(n=727).According to the proportion of 7:3,930 cases were randomly divided into the training set(n=651)and the validation set(n=279).Univariate and multivariate Logistic regression analyses were employed to identify preoperative,intraoperative,and postoperative risk factors for postoperative infection following hepatectomy.Based on the preoperative and postoperative risk factors,the nomogram models for predicting postoperative infection were constructed and validated,respectively.Results Multivariate Logistic analysis identified that,following were independent risk factors for preoperative prediction model:intrahepatic bile duct stones(OR=5.60),the operation time>240 min(OR=1.76),open or converted to open surgery(OR=3.59),intraoperative blood loss>300 mL(OR=1.89),and preoperative total bilirubin(TBIL)>34 μmol/L(OR=3.34);following were independent risk factors for postoperative prediction model:intrahepatic bile duct stones(OR=4.62),open/converted to open surgery(OR=2.57),intraoperative blood loss>300 mL(OR=2.09),postoperative intra-abdominal hemorrhage(OR=6.94),bile leakage(OR=14.61),elevated neutrophil percentage(NEU%)on day 3 postoperatively(OR=2.11),TBIL>34 μmol/L on day 3 postoperatively(OR=3.25),and neutrophil percentage-to-albumin ratio(NPAR)>20 day 3 postoperatively(OR=3.19).The preoperative prediction model achieved an AUC value of 0.75(95%CI 0.71 to 0.80),and the postoperative prediction model demonstrated improved AUC value of 0.84(95%CI 0.80 to 0.88).The-2 log-likelihood values indicated superior goodness-of-fit for the postoperative prediction model than that of preoperative mode(483.39 vs 593.15).Decision curve analysis further confirmed higher net benefit for the postoperative prediction model in clinical utility.Conclusion The primary risk factors for postoperative infections following hepatectomy include intrahepatic bile duct stones,open or convert to open surgery,intraoperative blood loss>300 mL,postoperative intra-abdominal hemorrhage,and bile leakage.The postoperative prediction model demonstrates superior predictive efficacy,which provids a more precise assessment tool for postoperative infection following hepatectomy.关键词
肝切除术/术后感染/危险因素/列线图/预测模型/术前指标/术后指标Key words
hepatectomy/postoperative infection/risk factors/nomogram/prediction model/preoperative indicators/postoperative indicators分类
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王泽桐,唐洁,张起帆,崔忠林,杨陈凤麟,李芷西,周杰..肝切除术后感染危险因素分析及列线图模型的构建与验证[J].肝胆胰外科杂志,2025,37(5):313-320,325,9.
