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预测肝移植后的VRE感染,使用时间更新的殖民分数.

Nathalia N Nunes1,2, Adhemar Villani Junior3, Lohayne A Ferreira1

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在肝移植后,确定了抗万科米辛抗性肠球菌 (VRE) 感染的风险因素. 移植后的时间更新的VRE殖民是最强的预测因素,有助于开发VRE感染的预测模型.

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科学领域:

  • 肝病学和移植手术 肝病学和移植手术
  • 传染性疾病 传染性疾病
  • 医疗信息学 医疗信息学

背景情况:

  • 抗万科胺素抗性肠球菌 (VRE) 感染对肝移植 (LT) 接受者构成重大威胁.
  • 识别VRE感染的风险因素对于改善LT后患者的治疗结果至关重要.

研究的目的:

  • 确定肝移植后与VRE感染相关的关键风险因素.
  • 在LT接受者中开发VRE感染的预测得分.

主要方法:

  • 成年LT接受者的回顾性队列研究 (2010-2022年).
  • 使用精细灰色模型进行时间到事件分析,用于VRE殖民的时间依赖共变量.
  • 作为比较器的机器学习 (随机森林),由AUROC评估的模型歧视.

主要成果:

  • 在1209名LT接受者中,6.3%发生了VRE感染;腹部内感染是最常见的.
  • 时间更新后的LT VRE殖民 (HR 7.59) 是最强的预测因素.
  • 其他危险因素包括手术内出血,再移植,LT前殖民和RRT;某些疾病,如病毒性肝炎和自身免疫性肝炎具有保护作用.

结论:

  • 结合已识别的风险因素的预测模型,特别是LT后的VRE殖民,可以有效地识别具有VRE感染高风险的LT接受者.
  • 该模型显示出良好的区分和平衡的敏感性/特异性,有助于临床风险分层.