摘要
Abstract
Objective To explore the characteristics of serum gasdermin-D(GSDMD)in patients with acute hepatic failure(AHF)and analyze the risk factors for fungal infections during hospitalization.Methods A retrospective analysis was per-formed on AHF patients admitted to the Third Affiliated Hospital of Chongqing Medical University from January 2022 to November 2024.Patients were divided into fungal infection group and non-fungal infection group based on the presence of fungal infection during hospitalization.Clinical characteristics and GSDMD levels were compared between the two groups.Logistic regression analysis was further used to screen independent risk factors for fungal infection in AHF patients.Receiver operating characteristic(ROC)curves were plotted to calculate the area under the curve(AUC)for evaluating the predictive efficacy of GSDMD and combined risk factors,calibration curves for assessing model fit,and decision curves for evaluating net clinical benefit.Results Among 246 enrolled AHF patients(151 males,95 females;median age 50[47,51]years),38(15.4％)developed fungal infections during hospitalization,predominantly caused by Candida albicans(22 cases,57.9％)and showed as respiratory infections(24 cases,63.2％).Compared with the non-fungal infection group,the fungal infection group showed significantly higher radio of older age,diabetes prevalence,hospital stay,intensive care unit(ICU)admission rate,ICU stay,mechanical ventilation rate,antibiotic types,antibiotic duration,glucocorticoid use,serum C-reactive pro-tein(CRP)and procalcitonin(PCT)levels,as well as lower serum IgG levels(all P＜0.05).Multivariate logistic regres-sion identified age[OR(95％CI)=1.493(1.070-2.083)],mechanical ventilation[OR(95％CI)=1.630(1.208-3.756)],glucocorticoid use[OR(95％CI)=2.105(1.950-4.667)],ICU stay[OR(95％CI)=6.070(1.594-23.114)],antibiotic duration[OR(95％CI)=4.180(1.440-12.133)],serum CRP[OR(95％CI)=1.135(1.065-1.210)],and GSDMD[OR(95％CI)=1.030(1.017-1.044)]as independent risk factors for fungal infection(all P＜0.05).The calibration curve and Bootstrap internal validation showed high model fit(x2=6.67,P=0.57).The ROC curve revealed an AUC of 0.92(0.88-0.97)for the combined model,and decision curve analysis indicated positive net clinical benefit across a threshold probability range of 0.0-0.9.Conclusion Age,mechanical ventilation,use of glucocorticoids,length of ICU stays,duration of antibi-otic use,serum CRP,GSDMD are independent risk factors for fungal infections during hospitalization in AHF patients.关键词
急性肝功能衰竭/真菌感染/消皮素D/危险因素Key words
acute hepatic failure/fungal infections/GSDMD/risk factors分类
医药卫生
