广西医学

目的构建ICU患者发生导管相关尿路感染（CAUTI）的风险列线图预测模型。方法纳入821例留置导尿管的ICU患者，其中589例作为建模组，232例作为验证组。记录患者的CAUTI发生情况，收集CAUTI发生前的临床资料。基于建模组数据，采用多因素Logistic回归模型分析ICU患者发生CAUTI的影响因素，并根据影响因素构建列线图预测模型。在验证组中，采用受试者工作特征（ROC）曲线和Hosmer⁃Lemeshow检验对模型进行内部及外部验证。结果 821例患者中，CAUTI发生率为4.99%（41/821）。留置导尿管时间、糖尿病合并情况、血清白蛋白水平、尿亚硝酸盐阳性情况是ICU患者发生CAUTI的影响因素（P<0.05）。基于以上4个因素构建列线图预测模型，内部及外部验证结果均提示模型具有较好的拟合度（Hosmer⁃Lemeshow检验结果显示χ 2=4.347、P=0.739，χ 2=4.632、P=0.796），ROC曲线下面积分别为0.890、0.781。结论留置导尿管时间≥7 d、合并糖尿病、血清白蛋白水平<40 g/L、尿亚硝酸盐阳性的ICU患者发生CAUTI的风险增加。基于上述因素构建的列线图预测模型有助于医护人员筛查发生CAUTI的高危ICU患者，从而尽早制订预防措施以降低感染风险。

To establish the nomogram prediction model of risk for ICU patients suffering from catheter⁃associated urinary tract infection (CAUTI). Methods A total of 821 ICU patients with indwelling urethral catheter were enrolled, therein 589 cases were regarded as modeling group, and 232 cases as validation group. The occurrence states of CAUTI in patients were recorded, and the clinical data before CAUTI occurrence were collected. The multivariate Logistic regression model was used to analyze the influencing factors for ICU patients suffering from CAUTI based on the data from the modeling group. The nomogram prediction model was established according to the influencing factors. In the validation group, the internal and external validations of the model were performed by employing the receiver operating characteristic (ROC) curve and Hosmer⁃Lemeshow test. Results The incidence rate of CAUTI among 821 patients was 4.99% (41/821). Indwelling duration for urethral catheter, comorbidity of diabetes mellitus, serum albumin level, and urine positive for nitrite were the influencing factors for ICU patients suffering from CAUTI (P<0.05). The nomogram prediction model was established based on the aforementioned 4 indices, and both internal and external validations results indicated that the model had a good degree of fit (the results of Hosmer⁃Lemeshow test revealed that χ2=4.347, P=0.739, χ2=4.632, P=0.796). Areas under the ROC curve were 0.890 and 0.781, respectively. Conclusions Indwelling duration of urethral catheter≥7 days, concomitant diabetes mellitus, serum albumin level<40 g/L, urine positive for nitrite increase the risk of ICU patients suffering from CAUTI. The nomogram prediction model established based on the aforementioned factors is helpful for medical and nursing personnel to screen high⁃risk ICU patients suffering from CAUTI, so as to formulate prevention measures to reduce the risk of infection as soon as possible.

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