枕下乙状窦后入路术后继发颅内感染风险预测评分模型的构建与验证
作者:
作者单位:

1.徐州医科大学附属医院神经外科,江苏 徐州 221000;2.徐州市红十字血液中心,江苏 徐州 221006

作者简介:

汤宏杰(1994—),男,硕士研究生在读,规培医师,就读于徐州医科大学神经外科专业,目前规培于徐州医科大学附属医院,主要从事神经肿瘤及神经重症的研究,Email:1228004896@qq.com。

通信作者:

冯力(1972—),男,主任医师,副教授,硕士研究生导师,博士学位,主要从事脑血管病、神经肿瘤以及神经重症的研究,Email:david1371@163.com。

基金项目:

国家自然科学基金青年科学基金项目(编号:81802490)。


Construction and validation of risk prediction model for postoperative intracranial infection after suboccipital retrosigmoid surgery
Author:
Affiliation:

1.Department of Neurosurgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000, China;2.Xuzhou Red Cross Blood Center, Xuzhou, Jiangsu 221006, China

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    摘要:

    目的 探讨枕下乙状窦后入路术后颅内感染的危险因素并构建风险预测模型。方法 收集2018年12月—2020年12月徐州医科大学附属医院行枕下乙状窦后入路手术患者的临床资料共258例,按照7∶3比例随机分为建模组(180例)和验证组(78例),随机种子为20210528,利用单因素和Logistic多因素筛选此入路术后颅内感染的危险因素,依据偏回归系数(b值)对危险因素赋值,构建感染风险预测评分模型。建模组数据进行模型内部验证,并对患者进行风险评分,验证组数据进行外部验证,利用受试者工作特征(ROC)曲线下面积(AUC)以及Hosmer-Lemeshow(H-L)检验评估模型的区分度及校准度。结果 多因素分析显示,术后改良格拉斯哥预后评分2分、硬脑膜剪开前未予过氧化氢冲洗、内镜联合显微镜的手术方式、静脉窦破裂、手术时间≥3.5 h是此入路术后颅内感染的危险因素,评分模型相应分值分别为6、6、6、5及4分,得分20~27分为高风险患者。建模组AUC为0.896(95%CI:0.840~0.952,P<0.001);验证组AUC为0.896(95%CI:0.782~0.999,P<0.001),两组H-L检验,差异有统计学意义(P>0.05),模型具有较好的区分度与校准度。结论 该研究所构建的枕下乙状窦后入路术后颅内感染风险预测模型具有较好的预测效能,可用于筛选此入路术后颅内感染高危人群。 [国际神经病学神经外科学杂志, 2022, 49(3): 26-31.]

    Abstract:

    Objective To investigate the risk factors for postoperative intracranial infection after suboccipital retrosigmoid surgery, and to construct a risk prediction model.Methods The clinical data of 258 patients undergoing surgeries via the suboccipital retrosigmoid approach in the Affiliated Hospital of Xuzhou Medical University from December 2018 to December 2020 were collected and randomly divided into modeling group (180 patients) and validation group (78 patients) in a 7:3 ratio, with a random seed of 20210528. Univariate and multivariate logistic analyses were used to screening the risk factors for postoperative intracranial infection after surgeries via the approach, and the risk factors were assigned according to the partial regression coefficient (β value) to construct the infection risk prediction model. The internal validation of the model was performed using the data of the modeling group, and the risk scores of patients were evaluated. The external validation was performed using the data of the validation group. The area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow (H-L) test were used to evaluate the discrimination and calibration of the model.Results The multivariate analysis showed that 2 points of postoperative modified Glasgow prognostic score, no hydrogen peroxide irrigation before dural incision, the surgery method of endoscopy combined with microscopy, venous sinus rupture, and an operation time of ≥3.5 h were risk factors for postoperative intracranial infection after surgeries via the approach, with the corresponding scores in the model of 6, 6, 6, 5 and 4 points. A score of 20-27 points indicated high-risk patients. The AUC was 0.896 in the modeling group (95% confidence interval [CI]: 0.840-0.952, P <0.001) and 0.896 in the validation group (95% CI: 0.782-0.999, P <0.001). The results of H-L tests in the two groups were P >0.05, indicating that the model had good discrimination and calibration.Conclusion The risk prediction model for postoperative intracranial infection after suboccipital retrosigmoid surgery constructed in this study has a good prediction performance and can be used to screen for high-risk groups of postoperative intracranial infection after surgeries via the approach. [Journal of International Neurology and Neurosurgery, 2022, 49(3): 26-31.]

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汤宏杰,庄星星,聂耳,郭庆,蒋中,冯力.枕下乙状窦后入路术后继发颅内感染风险预测评分模型的构建与验证[J].国际神经病学神经外科学杂志,2022,49(3):26-31

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  • 收稿日期:2021-11-19
  • 最后修改日期:2022-05-18
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  • 在线发布日期: 2022-07-29
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