中国卒中杂志2025，Vol.20Issue(7)：840-850,11.DOI:10.3969/j.issn.1673-5765.2025.07.006
老年急性卒中患者医院感染预测模型的构建与验证
Construction and Validation of a Prediction Model for Nosocomial Infection in Elderly Patients with Acute Stroke
摘要
Abstract
Objective To explore the risk factors of nosocomial infection in elderly patients with acute stroke and to establish and evaluate a prediction model. Methods Elderly patients with acute stroke who were hospitalized in the Department of Neurology,Beijing Tiantan Hospital,Capital Medical University from June 2019 to December 2021 were retrospectively selected as the study objects.Patients were divided into the infected group and the non-infected group according to whether nosocomial infection occurred.The data set was split into the training set and test set at a ratio of 7∶3,with the training set used to establish the model and the test set to evaluate the model's performance.Univariate and multivariate analyses were performed on the training set to screen for influencing factors and construct a nomogram prediction model.The predictive capability of the model was evaluated in terms of accuracy,discrimination,and clinical utility through the Hosmer-Lemeshow goodness of fit test,calibration curve plotting,ROC curve analysis,and decision curve analysis(DCA). Results A total of 2201 elderly patients with acute stroke were included in this study,with an average age of(68.9±6.9)years,and 68.92％(1517/2201)were male.The overall nosocomial infection rate was 12.22％(269/2201),among which the pulmonary infection rate was 9.72％(214/2201),the urinary system infection rate was 2.50％(55/2201),and the central nervous system infection rate was 0.50％(11/2201).The nosocomial infection rates of ischemic stroke,intracerebral hemorrhage,and subarachnoid hemorrhage patients were 10.31％,15.88％,and 29.29％,respectively,with statistically significant differences(P＜0.001).Multivariate analysis results showed that age ≥75 years,history of chronic obstructive pulmonary disease or peptic ulcer,NIHSS scores of 5-15 and 16-42 at admission,mRS score≥3 at admission,albumin＜35 g/L,high white blood cell count and neutrophil to lymphocyte ratio,and surgical treatment were independent risk factors for nosocomial infection.These factors were incorporated into the nomogram prediction model.The Hosmer-Lemeshow goodness of fit test results for the training set and test set both showed P＞0.05(the training set x2=9.294,P=0.318;the test set x2=10.173,P=0.253),indicating that the model has a good fit.The calibration curve showed good agreement between predicted and actual values.The AUC values of the training set and test set were 0.847(95％CI 0.819-0.876)and 0.838(95％CI 0.786-0.890),respectively,indicating that the model had good predictive ability and discrimination.DCA showed that the prediction model had high clinical utility. Conclusions The nomogram prediction model constructed in this study can effectively predict the risk of nosocomial infection in elderly patients with acute stroke.关键词
老年患者/卒中/医院感染/预测模型/列线图Key words
Elderly patient/Stroke/Nosocomial infection/Prediction model/Nomogram分类
医药卫生引用本文复制引用
李静,程实,郭军平,胡爱香,于鑫玮,韩玮,张越巍,冀瑞俊..老年急性卒中患者医院感染预测模型的构建与验证[J].中国卒中杂志,2025,20(7):840-850,11.基金项目
首都医科大学附属北京天坛医院自选科研项目(HX-B-2024011) （HX-B-2024011）
