| 王梦圆,陈佳龙,钟雪峰,等.基于MIMIC-Ⅳ数据库的中心静脉导管相关血流感染患者白细胞计数与院内死亡风险的相关性研究[J].中国临床保健杂志,2025,28(1):103-109. |
| 基于MIMIC-Ⅳ数据库的中心静脉导管相关血流感染患者白细胞计数与院内死亡风险的相关性研究 |
| Correlation between white blood cell count and in-hospital mortality risk in patients with central line-associated bloodstream infection:a study based on the MIMIC-Ⅳ database |
| 投稿时间：2024-11-17 |
| DOI：10.3969/J.issn.1672-6790.2025.01.019 |
| 中文关键词: 白细胞计数 中心静脉导管 保护因素 危险因素 医院死亡率 |
| 英文关键词: White blood cell Central venous catheters Protective factors Risk factors Hospital mortality 〖FL |
| 基金项目:中国医学科学院医学与健康科技创新工程项目(2021-I2M-1-044) |
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| 中文摘要: |
| 目的 探讨白细胞计数(WBC)是否可作为中心静脉导管相关血流感染(CLA-BSI)患者预后评估的生物标志物及其与院内死亡风险的相关性。方法 从重症医学监护信息数据库Ⅳ(MIMIC-Ⅳ)中提取561例被诊断为CLA-BSI的患者基本信息,以是否发生院内死亡分为幸存组(516例)和死亡组(45例),比较2组临床和实验室指标差异,应用二元logistic回归分析院内死亡的独立风险因素。采用限制性立方样条(RCS)模型分析WBC与院内死亡风险之间的计量反应关系。构建受试者工作特征(ROC)曲线,确定WBC作为院内死亡的预测因子的最佳截断值。运用二元logistic回归对分组后的WBC与院内死亡的相关性进行分析,并根据年龄、性别、脓毒性休克、序贯器官衰竭(SOFA)评分和CLA-BSI致病菌进一步行亚组分析,以确定混杂影响。结果多因素logistic回归显示,年龄(OR=1.04,95%CI:1.02~1.07)、WBC(OR=1.05,95%CI:1.01~1.08)及SOFA评分(OR=1.23,95%CI:1.12~1.35)是CLA-BSI患者院内死亡的独立风险因素。RCS分析显示,WBC和院内死亡间无明显非线性计量反应关系(P=0.064)。WBC预测院内死亡的 ROC曲线分析显示截断值为11.65×109/L。在男性和女性、年龄较大(≥60岁)或 SOFA 评分>6的亚组中WBC<11.65×109/L对院内死亡均具有保护作用(分别为OR=0.20,95%CI:0.07~0.59；OR=0.19,95%CI:0.07~0.48；OR=0.15,95%CI:0.06~0.36；OR=0.18,95%CI:0.07~0.42)。革兰阳性菌感染引起的亚组中,WBC<11.65×109/L 的患者具有更低的院内死亡风险(OR=0.16,95%CI:0.07~0.41)。结论 WBC<11.65×109/L是CLA-BSI患者发生院内死亡的保护因素,特别是在年龄≥60岁、SOFA评分>6分和革兰阳性菌感染的患者中。 |
| 英文摘要: |
| Objective To investigate the potential of white blood cell count (WBC) as a prognostic biomarker for patients with catheter-related bloodstream infection (CLA-BSI) and its correlation with the risk of in-hospital mortality.Methods The study extracted basic information in 561 patients diagnosed with CLA-BSI from MIMIC-Ⅳ and divided them into a survivor group (516 patients) and a death group (45 patients) based on whether they died in-hospital or not.Subsequently,the study compared the differences in clinical and laboratory indicators between the two groups,and a binary logistic regression analysis was conducted to ascertain whether the variables were independent factors associated with in-hospital mortality.The restricted cubic spline (RCS) model was employed to examine the relationship between WBC and in-hospital mortality.Receiver operating characteristic (ROC) curves were constructed in order to determine the optimal cut-off value for WBC as a predictor of in-hospital mortality.Binary logistic regression was used to analyze the correlation between the grouped WBC and in-hospital mortality.Subgroup analyses were conducted to ascertain the potential confounding effects of age,sex,septic shock,Sequential Organ Failure Assessment(SOFA)score,and the pathogens of CLA-BSI.Results The results of the multivariate logistic regression analysis indicated that age (OR=1.04,95%CI:1.02-1.07),WBC (OR=1.05,95%CI:1.01-1.08) and SOFA score (OR=1.23,95%CI:1.12-1.35) were independent risk factors for the in-hospital death of patients with CLA-BSI.The RCS analysis indicated the presence of a non-significant nonlinear measured response relationship between WBC and in-hospital death (P=0.064).A ROC analysis of WBC counts predicting in-hospital death revealed a cut-off value of 11.65×109/L.A WBC count of less than 11.65×109/L was found to be protective against in-hospital death in all subgroups,including males and females,individuals aged ≥60 years old,and those with a SOFA score>6 (OR=0.20,95%CI:0.07-0.59;OR=0.19,95%CI:0.07-0.48;OR=0.15,95%CI:0.06-0.36;OR=0.18,95%CI:0.07-0.42,respectively).In the subgroup of cases caused by gram-positive bacterial infections,patients with a WBC of less than 11.65×109/L exhibited a reduced risk of in-hospital mortality (OR=0.16,95%CI:0.07-0.41).Conclusions WBC<11.65×109/L is identified as a protective factor for in-hospital mortality in patients with CLA-BSI,particularly in those patients (≥ 60 years old,SOFA scores>6,and Gram-positive bacterial infections). |
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