摘要
Abstract
Objective To explore risk factors for fungal infection in patients with acute severe pancreatitis(ASP)to con-struct a prediction model and evaluate its application value.Methods Forty-six patients with severe acute pancreatitis com-plicated with fungal infection admitted to the Gastroenterology Department and Emergency Department of the First Affiliated Hospital of the Military Air Force Medical University from March 2021 to February 2024 were selected as the infected group,and 138 patients without fungal infection were selected as the non-infected group.The distribution of infection sites and fungal species in the infection group was analyzed.Demographic characteristics,clinical data,and laboratory indicators were compared between the two groups to screen potential factors affecting fungal infection in ASP patients.Logistic regres-sion analysis was used to identify related risk factors and establish a regression prediction model.The Hosmer-Lemeshow test was used to evaluate model calibration,and the receiver operating characteristic(ROC)curve was plotted to assess mod-el discrimination.Results A total of 49 fungal strains were isolated from 46 patients with fungal infection,mainly Candida albicans(48.98％),Candida tropicalis(22.45％),and Candida glabrata(14.29％).The infections were mainly com-posed of,primarily respiratory tract(24.64％),digestive tract(23.19％),urinary system(20.29％),and pancreas or peripancreatic area(15.94％).Multivariate logistic regression analysis showed that risk factors for fungal infection in ASP patients were antibiotic use categories(OR=2.794,95％CI:1.559-5.008),age(OR=2.823,95％CI:1.083-7.359),co-morbid diabetes(OR=4.408,95％CI:1.242-15.647),fasting duration(OR=1.598,95％CI:1.264-2.022),and ICU length of stay(OR=2.361,95％CI:1.637-3.405).A prediction model was established based on the regression coefficientsβ of each risk factor.The Hosmer-Lemeshow test showed P=0.558,indicating effective model construction.The ROC curve analysis revealed that the area under the curve(AUC)for predicting fungal infection in ASP patients was 0.985(95％CI:0.970-0.999),with a sensitivity of 93.48％and specificity of 94.93％.Conclusion Candida albicans is the most com-mon fungal pathogen in ASP patients,with the respiratory and digestive tracts being the most susceptible sites.Age,co-morbid diabetes,fasting duration,ICU length of stay,and antibiotic use categories are risk factors.The prediction model constructed based on these factors demonstrates good predictive power.关键词
急性重症胰腺炎/真菌感染/危险因素/预测模型/重症监护Key words
acute severe pancreatitis/fungal infection/risk factors/prediction model/intensive care分类
医药卫生
