诊断学理论与实践 ›› 2025, Vol. 24 ›› Issue (04): 441-448.doi: 10.16150/j.1671-2870.2025.04.011
杨梅, 廖啟安, 谭全会, 李婷婷, 张毅, 陈洁, 汤正好()
收稿日期:
2024-12-31
修回日期:
2025-03-20
接受日期:
2025-08-07
出版日期:
2025-08-25
发布日期:
2025-09-09
通讯作者:
汤正好 E-mail:tzhhao@163.com基金资助:
YANG Mei, LIAO Qi'an, TAN Quanhui, LI Tingting, ZHANG Yi, CHEN Jie, TANG Zhenghao()
Received:
2024-12-31
Revised:
2025-03-20
Accepted:
2025-08-07
Published:
2025-08-25
Online:
2025-09-09
摘要:
目的:探讨医院获得性细菌性脑膜炎(hospital-acquired bacterial meningitis, HABM)患者预后不良的危险因素,并构建预测其发生的列线图模型。方法:连续纳入上海交通大学医学院附属第六人民医院2013年1月至2020年12月收治的110例医院获得性细菌性脑膜炎患者,根据出院时是否死亡将其分为死亡组(n=22)和生存组(n=88),同时随机将110例患者分为建模组(n=77)和验证组(n=33)。应用最小绝对收缩和选择算子(least absolute shrinkage and selection operator,LASSO)回归及多因素Logistic回归筛选HABM患者预后不良的危险因素,并基于危险因素构建列线图模型,采用受试者操作特征(receiver operating characteristic curve,ROC)曲线的曲线下面积(area under curve,AUC)评估模型区分度,用校准曲线评估模型内部一致性情况。结果:基于LASSO回归共筛选出脑脊液(cerebro-spinal fluid,CSF)微生物培养革兰染色阳性、血常规中性粒细胞计数升高、降钙素原升高、CSF蛋白含量升高、凝血酶原时间缩短、血培养阳性、腰池引流史这7个因素,建立了HABM预后不良列线图预测模型,建模组及验证组ROC曲线的AUC分别为0.931、0.862,校准图显示校准曲线与理想曲线吻合较好,具有良好的拟合优度。结论:本研究构建危险因素列线图模型对住院HABM患者死亡具有较好的预测性、一致性和临床实用性,有助于临床医生对HABM患者预后不良的发生风险进行初步评估。
中图分类号:
杨梅, 廖啟安, 谭全会, 李婷婷, 张毅, 陈洁, 汤正好. 医院获得性细菌性脑膜炎患者预后不良的危险因素分析及列线图预测模型的构建[J]. 诊断学理论与实践, 2025, 24(04): 441-448.
YANG Mei, LIAO Qi'an, TAN Quanhui, LI Tingting, ZHANG Yi, CHEN Jie, TANG Zhenghao. Analysis of risk factors for poor prognosis in patients with hospital-acquired bacterial meningitis and establishment of nomogram prediction model[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(04): 441-448.
表1
生存组与死亡组患者一般资料比较
Characteristics | Death group (n=22) | Survival group (n=88) | P-value | Characteristics | Death group (n=22) | Survival group (n=88) | P value |
---|---|---|---|---|---|---|---|
Age(years) | 61 ± 11 | 55 ± 13 | 0.057 | Antithrombin Ⅲ activity(%) | 65 ± 25 | 89 ± 16 | <0.001 |
Sex(%) | 0.483 | More than two surgeries(%) | 0.212 | ||||
Female | 9 (40.9%) | 29 (33.0%) | No | 13 (59.1%) | 64 (72.7%) | ||
Male | 13 (59.1%) | 59 (67.0%) | Yes | 9 (40.9%) | 24 (27.3%) | ||
Admission GCS | 7.9 ± 4.0 | 9.3 ± 3.7 | 0.073 | blood culture(%)) | 0.001 | ||
Gram stain of CSF microbial[n(%)] | 0.01 | No | 11 (50.0%) | 73 (83.0%) | |||
Negetive | 13 (59.1%) | 26 (29.5%) | Yes | 11 (50.0%) | 15 (17.0%) | ||
Positive | 9 (40.9%) | 62 (70.5%) | GCS on the day of culture | 7.5 ± 3.3 | 9.4 ± 3.5 | 0.018 | |
CSF Chloride(mmol/L) | 120 ± 17 | 119 ± 16 | 0.988 | Surgical incision length greater than 10 cm(%) | 0.19 | ||
CSF Sugar(mmol/L) | 2.26 ± 2.13 | 3.50 ± 2.14 | 0.02 | No | 12 (54.5%) | 61 (69.3%) | |
CSF protein(mmol/L) | 5.6 ± 5.3 | 4.2 ± 12.8 | 0.023 | Yes | 10 (45.5%) | 27 (30.7%) | |
CSF WBC>10(× 106/L) | 0.273 | Surgical time greater than 4 h(%) | 0.529 | ||||
<100 | 12 (54.5%) | 59 (67.0%) | No | 17 (77.3%) | 74 (84.1%) | ||
>100 | 10 (45.5%) | 29 (33.0%) | Yes | 5 (22.7%) | 14 (15.9%) | ||
CSF RBC[n(%)] | 0.775 | Tracheal intubation/incision greater than 7 days(%) | 0.021 | ||||
Little | 11 (50.0%) | 47 (53.4%) | No | 3 (13.6%) | 35 (39.8%) | ||
Many | 11 (50.0%) | 41 (46.6%) | Yes | 19 (86.4%) | 53 (60.2%) | ||
WBC(× 109/L) | 14.7 ± 7.2 | 11.7 ± 5.9 | 0.07 | Fever(%) | 0.306 | ||
Neutrophil(× 109/L) | 12.7 ± 6.7 | 10.6 ± 15.1 | 0.037 | No | 5 (22.7%) | 30 (34.1%) | |
RBC(× 1012/L) | 3.41 ± 0.57 | 3.66 ± 0.82 | 0.199 | Yes | 17 (77.3%) | 58 (65.9%) | |
PLT(× 109/L) | 226 ± 137 | 278 ± 107 | 0.019 | External ventricular drainage greater than 7 days(%) | 0.151 | ||
Neutrophil percentage(%) | 84 ± 8 | 77 ± 9 | <0.001 | No | 9 (40.9%) | 51 (58.0%) | |
Lymphocytes(× 109/L) | 1.07 ± 0.56 | 1.31 ± 0.59 | 0.087 | Yes | 13 (59.1%) | 37 (42.0%) | |
Monocytes(× 109/L) | 0.76 ± 0.42 | 0.81 ± 0.53 | 0.994 | CSF leakage(%) | 0.684 | ||
Average platelet volume(fL) | 11.41 ± 1.62 | 10.52 ± 1.09 | 0.02 | No | 21 (95.5%) | 80 (90.9%) | |
Platelet mean width(fL) | 15.19 ± 3.80 | 13.77 ± 11.10 | 0.005 | Yes | 1 (4.5%) | 8 (9.1%) | |
Plateletcrit(%) | 0.25 ± 0.13 | 0.29 ± 0.11 | 0.087 | Extraspinal diversion(%) | 0.049 | ||
Albumin (g/L) | 33.2 ± 5.3 | 36.3 ± 4.8 | 0.002 | No | 18 (81.8%) | 84 (95.5%) | |
Albumin to globulin ratio | 1.48 ± 0.41 | 1.51 ± 0.36 | 0.403 | Yes | 4 (18.2%) | 4 (4.5%) | |
CRP(mg/L) | 79 ± 38 | 56 ± 47 | 0.003 | V-P shunting(%) | 0.755 | ||
Procalcitonin(ng/mL) | 1.40 ± 1.83 | 0.32 ± 0.38 | <0.001 | No | 18 (81.8%) | 74 (84.1%) | |
D-D(mg/L) | 4.1 ± 4.3 | 4.1 ± 4.1 | 0.799 | Yes | 4 (18.2%) | 14 (15.9%) | |
PT(s) | 14.19 ± 2.06 | 12.26 ± 1.31 | <0.001 | Diplopneumonia(%) | 0.09 | ||
INR | 1.69 ± 2.10 | 1.07 ± 0.12 | <0.001 | No | 3 (13.6%) | 28 (31.8%) | |
APTT(s) | 38 ± 15 | 29 ± 7 | 0.003 | Yes | 19 (86.4%) | 60 (68.2%) | |
Fibrinogen(g/L) | 3.97 ± 1.54 | 4.00 ± 2.14 | 0.893 | Deep vein cannulation(%) | 0.017 | ||
Prothrombin time(s) | 16.84 ± 2.28 | 16.30 ± 1.85 | 0.168 | No | 2 (9.1%) | 31 (35.2%) | |
FDP(mg/L) | 13 ± 12 | 13 ± 11 | 0.751 | Yes | 20 (90.9%) | 57 (64.8%) |
表2
建模组与验证组患者临床资料比较
Characteristic | Cohort | P-value | Characteristic | Cohort | P value | ||
---|---|---|---|---|---|---|---|
Training Cohort (n=77) | Internal Test Cohort (n=33) | Training Cohort (n=77) | Internal Test Cohort (n=33) | ||||
Age(years) | 57 ± 12 | 55 ± 14 | 0.524 | Extraspinal diversion(%) | 0.431 | ||
Sex(%) | 0.861 | No | 70 (90.9%) | 32 (97.0%) | |||
Female | 27 (35.1%) | 11 (33.3%) | Yes | 7 (9.1%) | 1 (3.0%) | ||
Male | 50 (64.9%) | 22 (66.7%) | CSF leakage(%) | 0.448 | |||
Gram stain of CSF microbial | 0.317 | No | 72 (93.5%) | 29 (87.9%) | |||
Negetive | 25 (32.5%) | 14 (42.4%) | Yes | 5 (6.5%) | 4 (12.1%) | ||
Positive | 52 (67.5%) | 19 (57.6%) | V-P shunting(%) | 0.043 | |||
CSF Chloride(mmol/L) | 119 ± 18 | 119 ± 12 | 0.834 | No | 68 (88.3%) | 24 (72.7%) | |
CSF Sugar(mmol/L) | 3.55 ± 2.33 | 2.56 ± 1.64 | 0.013 | Yes | 9 (11.7%) | 9 (27.3%) | |
CSF protein(mmol/L) | 5.0 ± 13.7 | 3.3 ± 3.6 | 0.32 | Diplopneumonia(%) | 0.432 | ||
CSF RBC(%) | 0.56 | No | 20 (26.0%) | 11 (33.3%) | |||
Little | 42 (54.5%) | 16 (48.5%) | Yes | 57 (74.0%) | 22 (66.7%) | ||
Many | 35 (45.5%) | 17 (51.5%) | Deep vein cannulation(%) | 0.159 | |||
CSF WBC(× 106/L) | 0.896 | No | 20 (26.0%) | 13 (39.4%) | |||
<100 | 50 (64.9%) | 21 (63.6%) | Yes | 57 (74.0%) | 20 (60.6%) | ||
>100 | 27 (35.1%) | 12 (36.4%) | WBC(× 109/L) | 13.1 ± 6.6 | 10.5 ± 5.3 | 0.033 | |
Admission GCS | 9.1 ± 3.8 | 8.9 ± 3.7 | 0.786 | Neutrophil(× 109/L) | 12.2 ± 16.2 | 8.3 ± 4.6 | 0.053 |
Blood culture(%) | 0.281 | Neutrophil percentage(%) | 78 ± 10 | 78 ± 7 | 0.626 | ||
Negetive | 61 (79.2%) | 23 (69.7%) | Monocytes(× 109/L) | 0.84 ± 0.54 | 0.71 ± 0.43 | 0.175 | |
Positive | 16 (20.8%) | 10 (30.3%) | Lymphocytes(× 109/L) | 1.27 ± 0.59 | 1.27 ± 0.59 | 0.998 | |
More than two surge-ries(%) | 0.159 | PLT(× 109/L) | 243 ± 117 | 240± 120 | 0.164 | ||
No | 57 (74.0%) | 20 (60.6%) | Plateletcrit(%) | 0.26 ± 0.12 | 0.30 ± 0.15 | 0.876 | |
Yes | 20 (26.0%) | 13 (39.4%) | Albumin to globulin ratio | 11.39 ± 1.6 | 10.59 ± 1.15 | 0.335 | |
GCS on the day of culture | 8.9 ± 3.5 | 9.2 ± 3.5 | 0.723 | CRP(mg/L) | 81 ± 41 | 82 ± 23 | 0.445 |
Surgical incision length greater than 10 cm(%) | 0.692 | Procalcitonin(ng/mL) | 0.92 ± 0.8 | 1.2 ± 0.9 | 0.126 | ||
No | 52 (67.5%) | 21 (63.6%) | Average platelet volume(fL) | 10.82 ± 1.24 | 10.41 ± 1.26 | 0.118 | |
Yes | 25 (32.5%) | 12 (36.4%) | Platelet mean width(fL) | 13.23 ± 2.84 | 15.96 ± 17.91 | 0.391 | |
Surgical time greater than 4 h | 0.7 | RBC(× 1012/L) | 3.66 ± 0.85 | 3.48 ± 0.57 | 0.205 | ||
No(%) | 63 (81.8%) | 28 (84.8%) | Albumin (g/L) | 35.5 ± 4.9 | 36.2 ± 5.3 | 0.534 | |
Yes | 14 (18.2%) | 5 (15.2%) | Fibrinogen(g/L) | 4.09 ± 2.17 | 3.77 ± 1.68 | 0.405 | |
Tracheal intubation/ incision greater than 7 days(%) | 0.793 | APPT(s) | 30 ± 10 | 31 ± 10 | 0.669 | ||
No | 26 (33.8%) | 12 (36.4%) | INR | 1.23 ± 1.14 | 1.11 ± 0.15 | 0.376 | |
Yes | 51 (66.2%) | 21 (63.6%) | Prothrombin time(s) | 12.59 ± 1.65 | 12.78 ± 1.74 | 0.596 | |
Fever(%) | 0.823 | D-D(mg/L) | 4.2 ± 4.3 | 4.1 ± 3.7 | 0.908 | ||
No | 25 (32.5%) | 10 (30.3%) | PT(s) | 16.24 ± 1.72 | 16.80 ± 2.36 | 0.228 | |
Yes | 52 (67.5%) | 23 (69.7%) | FDP(mg/L) | 13 ± 12 | 14 ± 10 | 0.91 | |
External ventricular drainage greater than 7 days(%) | >0.999 | Antithrombin Ⅲ activity(%) | 86 ± 19 | 80 ± 23 | 0.226 | ||
No | 42 (54.5%) | 18 (54.5%) | Proealeitonin(ng/mL) | 275 ± 119 | 252 ± 105 | 0.332 | |
Yes | 35 (45.5%) | 15 (45.5%) |
[1] |
HASBUN R. Progress and challenges in bacterial meningitis: a review[J]. JAMA, 2022, 328(21):2147-2154.
doi: 10.1001/jama.2022.20521 pmid: 36472590 |
[2] | LI Z, YANG W, YE X, et al. Early intraventricular anti-biotic therapy improved in-hospital-mortality in neurocritical patients with multidrug-resistant bacterial nosocomial meningitis and ventriculitis[J]. Neurocrit Care, 2024, 40(2):612-620. |
[3] |
ZHANG Y, XIAO X, ZHANG J, et al. Diagnostic accuracy of routine blood examinations and CSF lactate level for post-neurosurgical bacterial meningitis[J]. Int J Infect Dis, 2017, 59:50-54.
doi: S1201-9712(17)30111-X pmid: 28392319 |
[4] | VAN DE BEEK D, CABELLOS C, DZUPOVA O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis[J]. Clin Microbiol Infect, 2016, 22(Suppl 3): S37-62. |
[5] | 姜秀国, 王辉, 顾明, 等. 成人社区获得性单核细胞增生李斯特菌脑膜炎[J]. 中华急诊医学杂志, 2012, 21(10):1140-1146. |
JIANG X G, WANG H, GU M, et al. Community acquired Listeria monocytogenes meningitis in adults[J]. Chin J Emerg Med, 2012, 21(10):1140-1146. | |
[6] |
TSAI M H, LU C H, HUANG C R, et al. Bacterial meningitis in young adults in Southern Taiwan: clinical characteristics and therapeutic outcomes[J]. Infection, 2006, 34(1):2-8.
doi: 10.1007/s15010-006-4144-6 pmid: 16501895 |
[7] |
WEISFELT M, VAN DE BEEK D, SPANJAARD L, et al. A risk score for unfavorable outcome in adults with bacterial meningitis[J]. Ann Neurol, 2008, 63(1):90-97.
pmid: 17823938 |
[8] |
VIBHA D, BHATIA R, PRASAD K, et al. Clinical features and independent prognostic factors for acute bacterial meningitis in adults[J]. Neurocrit Care, 2010, 13(2):199-204.
doi: 10.1007/s12028-010-9396-4 pmid: 20577910 |
[9] | 刘子林, 肖绍武, 叶琳, 等. 结核性脑膜炎患者预后情况调查及其相关影响因素分析[J]. 中国医学创新, 2021, 18(35):69-72. |
LIU Z L, XIAO S W, YE L, et al. Investigation of prognosis of tuberculous meningitis patients and analysis of related influencing factors[J]. Med Innov China, 2021, 18(35):69-72. | |
[10] | 李承, 孙丹, 王晶, 等. 90例儿童化脓性脑膜炎病原学及临床表现和预后[J]. 中华医院感染学杂志, 2022, 32(18):2856-2859. |
LI C, SUN D, WANG J, et al. Etiological characteristics,clinical manifestations and prognosis of 90 children with purulent meningitis[J]. Chin J Nosocomiol, 2022, 32(18):2856-2859. | |
[11] |
CHAKRABARTI P, DAS B K, KAPIL A. Application of 16S rDNA based seminested PCR for diagnosis of acute bacterial meningitis[J]. Indian J Med Res, 2009, 129(2):182-188.
pmid: 19293446 |
[12] |
VASILOPOULOU V A, KARANIKA M, THEODORIDOU K, et al. Prognostic factors related to sequelae in childhood bacterial meningitis: data from a Greek meningitis registry[J]. BMC Infect Dis, 2011, 11:214.
doi: 10.1186/1471-2334-11-214 pmid: 21827712 |
[13] | 刘梦迪, 徐发林, 段稳丽, 等. 新生儿细菌性脑膜炎预后不良的危险因素分析[J]. 中国当代儿科杂志, 2019, 21(11):1064-1068. |
LIU M D, XU F L, DUAN W L, et al. Risk factors for poor prognosis of neonatal bacterial meningitis[J]. Chin J Contemp Pediatr, 2019, 21(11):1064-1068. | |
[14] | 李海燕, 李君莲, 吴倩, 等. 结核性脑膜炎患者预后不良的危险因素分析及列线图预测模型的构建[J]. 中华神经医学杂志, 2023, 22(9):891-898. |
LI H Y, LI J L, WU Q, et al. Risk factors for poor prognosis in patients with tuberculous meningitis and establishment of their nomogram predictive models[J]. Chin J Neurol, 2023, 22(9):891-898. | |
[15] |
MEYFROIDT G, KURTZ P, SONNEVILLE R. Critical care management of infectious meningitis and encephalitis[J]. Intensive Care Med, 2020, 46(2):192-201.
doi: 10.1007/s00134-019-05901-w pmid: 31938828 |
[16] |
CITERIO G, SIGNORINI L, BRONCO A, et al. External ventricular and lumbar drain device infections in ICU patients: a prospective multicenter Italian study[J]. Crit Care Med, 2015, 43(8):1630-1637.
doi: 10.1097/CCM.0000000000001019 pmid: 25867904 |
[17] |
RAMANAN M, LIPMAN J, SHORR A, et al. A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections[J]. BMC Infect Dis, 2015, 15:3.
doi: 10.1186/s12879-014-0712-z pmid: 25567583 |
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