结合血清谷氨酰胺水平变化建立aSAH患者的医院获得性感染预测模型

Establishing a prediction model for HAI in aSAH patients via combining the variation in the serum level of glutamine

摘要:

目的 探讨肠内营养治疗的动脉瘤性蛛网膜下腔出血（aSAH）患者血清谷氨酰胺（Gln）水平变化与医院获得性感染（HAI）之间的关系。方法 选取2015年11月—2019年8月黄山市人民医院神经外科收治的aSAH患者115例，根据住院期间有无HAI分为感染组和未感染组。比较两组入院第1天与第2天血浆C反应蛋白、白蛋白差值和Gln下降率等临床资料，应用多因素Logistic回归分析患者发生HAI的相关因素，构建影响因素的列线图模型并验证。结果 两组患者性别、住院时间、Hunt和Hess分级、BMI、收缩压、高血压、动脉瘤部位比较，差异无统计学意义（P >0.05），感染组年龄、糖尿病比例高于未感染组（P <0.05）。两组患者白蛋白差值、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、空腹血糖比较，差异无统计学意义（P >0.05），感染组CRP差值、Gln下降率均高于未感染组（P <0.05），血红蛋白低于未感染组（P <0.05）。逐步多因素Logistic回归分析结果显示，CRP差值［O^R=1.750（95% CI：1.148，2.668）］和Gln下降率［O^R=2.219（95% CI：1.536，3.207）］为aSAH患者发生HAI的独立危险因素（P <0.05），血红蛋白［O^R=0.930（95% CI：0.886，0.976）］为独立保护因素（P <0.05）。列线图预测HAI的一致性指数为0.920（95% CI：0.876，0.939）。结论 接受肠内营养治疗的aSAH患者Gln下降率与HAI相关，结合Gln水平动态变化所构建的列线图具有良好的HAI预测价值。

Abstract:

Objective To explore the relationship between the variation in the serum level of glutamine (Gln) and the hospital-acquired infection (HAI) in aneurysmal subarachnoid hemorrhage (aSAH) patients treated with enteral nutrition.Methods A total of 115 aSAH patients treated in our hospital from November 2015 to August 2019 were included and divided into HAI group and non-HAI group according to whether they developed HAI during the hospitalization. The clinical data, including the differences of the plasma levels of C-reactive protein (ΔCRP), albumin (ΔALB), and tumor necrosis factor-α (ΔTNF-α) as well as the decline rate of Gln between the first day and the second day after admission, were compared between the two groups. The multivariable Logistic regression analysis was performed to determine the factors associated with the occurrence of HAI, and the nomogram model was established and validated.Results There was no difference in the sex composition, length of hospital stay, the grade of Hunt and Hess Scale, body mass index (BMI), systolic pressure, proportion of patients with hypertension, or the location of the aneurysms (P > 0.05), while the age was older and the prevalence of diabetes mellitus was higher in the HAI group compared with the non-HAI group (P < 0.05). There was no difference in ΔALB, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol or fasting blood glucose (P > 0.05). The ΔCRP, ΔTNF-α and the decline rate of Gln in the HAI group were higher than those in the non-HAI group (P < 0.05), and the hemoglobin level in the HAI group was lower than that in the non-HAI group (P < 0.05). The multivariable Logistic regression analysis revealed that ΔCRP [O^R = 1.750 (95% CI: 1.148, 2.668) ] and the decline rate of Gln [O^R = 2.219 (95% CI: 1.536, 3.207) ] were independent risk factors for the occurrence of HAI in aSAH patients (P < 0.05), while hemoglobin [O^R = 0.930, (95% CI: 0.886, 0.976) ] was an independent protective factor (P < 0.05). The consistency index of the nomogram for predicting the occurrence of HAI was 0.920 (95% Cl: 0.876, 0.939).Conclusions The decline rate of Gln in aSAH patients treated with enteral nutrition correlates with the occurrence of HAI. The nomogram model established via combining the variation in the Gln level exhibits a great predictive value for the occurrence of HAI.