Early prediction model of organ/space surgical site infection after elective gastrointestinal or hepatopancreatobiliary cancer surgery
Early prediction model of organ/space surgical site infection after elective gastrointestinal or hepatopancreatobiliary cancer surgery
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DOI：
10.1016/j.jiac.2020.04.009
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发表时间：
2020-09-01
影响因子：
2.2
通讯作者：
Kusanagi, Hiroshi
中科院分区：
文献类型：
--
作者：
Okui, Jun;Ueno, Ryo;Kusanagi, Hiroshi
背景：器官/空间 SSI 是一个重要的临床问题。然而，器官/空间 SSI 的早期检测很困难，并且以前的预测模型的预后能力有限。我们的目的是利用接受胃肠道或肝胰胆癌切除术的患者术后第3天的实验室数据来开发和验证器官/空间手术部位感染（SSI）的预测模型。方法：这项回顾性队列研究使用2013年4月至2017年9月的单中心医院数据，包括所有接受择期胃肠道或肝胰胆癌切除术的成年患者。主要结局是器官/空间 SSI 的存在，包括吻合口瘘、胰瘘、胆瘘或腹内脓肿。我们开发并验证了一个逻辑回归模型，以使用术后第 3 天 (POD) 的实验室数据来预测器官/空间 SSI。使用术后第 1 天或第 5 天的实验室数据开发了类似的模型，以比较每个模型的预测能力。结果：总共纳入了 1578 名患者。 107 名患者被诊断为器官/空间 SSI，手术后中位诊断天数为 6 天（四分位距，4-9 天）。使用 POD 3 上五个常用测量变量创建预测模型，曲线下面积 (AUC) 为 0.883 (95% CI 0.819-0.946)。 POD 1实验室数据模型的AUC为0.751（95％CI 0.655-0.848），而POD 5实验室数据模型的AUC为0.818（95％CI 0.730-0.906）。结论：POD 3实验室数据可以准确预测器官/空间SSI。需要进一步的前瞻性研究来调查该模型的临床影响。 (C) 2020 年日本化疗学会和日本传染病学会。由爱思唯尔有限公司出版。保留所有权利。
Background: Organ/space SSI is a significant clinical problem. However, early detection of organ/space SSI is difficult, and previous predictive models are limited in their prognostic ability. We aimed to develop and validate a prediction model of organ/space surgical site infection (SSI) using postoperative day 3 laboratory data in patients who underwent gastrointestinal or hepatopancreatobiliary cancer resection.Methods: This retrospective cohort study using a single-center hospital data from April 2013 to September 2017 included all adult patients who underwent elective gastrointestinal or hepatopancreatobiliary cancer resection. The primary outcome was a presence of organ/space SSI including anastomotic leakage, pancreatic fistula, biliary fistula, or intra-abdominal abscess. We developed and validated a logistic regression model to predict organ/space SSI using laboratory data on postoperative day (POD) 3. Similar models using laboratory data on POD 1 or 5 were developed to compare the predictive ability of each model.Results: A total of 1578 patients were included. Organ/space SSI was diagnosed in 107 patients, with median diagnosis days of 6 (interquartile range, 4-9 days) after surgery. A prediction model using five commonly measured variables on POD 3 was created with the area under the curve (AUC) of 0.883 (95% CI 0.819-0.946). The AUC of a model with POD 1 laboratory data was 0.751 (95%CI 0.655-0.848), while that of POD 5 laboratory data was 0.818 (95%CI 0.730-0.906).Conclusions: Laboratory data on POD 3 could forecast organ/space SSI precisely. Further prospective studies are warranted to investigate the clinical impact of this model. (C) 2020 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.