膀胱癌电切术后尿路感染Lasso-Logistic预测模型的构建

Construction of Lasso-Logistic prediction model for urinary tract infection after transurethral resection of bladder tumor

  • 摘要:
    目的 分析膀胱癌电切术后尿路感染(UTI)发生情况,并构建Lasso-Logistic预测模型。
    方法 选取2022年5月—2023年10月首都医科大学附属北京友谊医院行尿道膀胱肿瘤电切术(TURBT)治疗后的920例膀胱癌患者,统计术后UTI发生率。根据是否发生UTI分为UTI组和非UTI组,比较2组临床资料; 通过Lasso-Logistic回归分析膀胱癌患者术后UTI的影响因素,根据影响因素构建Lasso-Logistic预测模型; 通过受试者工作特征(ROC)曲线、决策曲线分析(DCA)评价模型的预测效能和临床效用。
    结果 膀胱癌患者TURBT后住院期间UTI发生率为12.50%(115/920); Lasso-Logistic回归分析显示,年龄、高血压、糖尿病、血清降钙素原(PCT)、白细胞介素-6(IL-6)、C反应蛋白(CRP)、外周血CD3+、CD4+/CD8+、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、尿液基质金属蛋白酶-7(MMP-7)、表面活性蛋白A(SP-A)和表面活性蛋白D(SP-D)均为膀胱癌患者术后发生UTI的独立影响因素(P < 0.05)。根据影响因素构建Lasso-Logistic预测模型为: Logit(P)=-2.516+1.109×年龄+1.002×糖尿病+1.359×高血压+1.496×CRP+1.726×PCT+1.562×IL-6-1.155×CD3+-1.280×CD4+/CD8+-1.032×IgA-1.411×IgM+1.589×MMP-7-0.843×SP-A-0.799×SP-D。ROC曲线结果显示, 该模型预测膀胱癌患者术后发生UTI的曲线下面积(AUC)为0.944(95%CI: 0.927~0.958), 敏感度、特异度分别为87.83%、85.22%; DCA结果显示,该模型具有明显的正向净收益。
    结论 膀胱癌患者TURBT后UTI发生率较高,根据影响因素构建Lasso-Logistic预测模型可为临床预测UTI发生风险提供可靠参考依据。

     

    Abstract:
    Objective To analyze the occurrence of urinary tract infection (UTI) after transurethral resection of bladder tumor and construct a Lasso-Logistic prediction model.
    Methods A total of 920 bladder cancer patients with transurethral resection of bladder tumor in Beijing Friendship Hospital Affiliated to Capital Medical University from May 2022 to October 2023 were selected, and the incidence of postoperative UTI was recorded. Patients were divided into UTI and non-UTI groups based on the occurrence of UTI, and clinical materials were compared between the two groups. Lasso-Logistic regression analysis was used to identify the influencing factors of postoperative UTI in bladder cancer patients, and a Lasso-Logistic prediction model was constructed based on these factors. The prediction performance and clinical utility of the model were evaluated through the receiver operating characteristic (ROC) curve and decision curve analysis (DCA).
    Results The incidence of UTI during hospitalization after transurethral resection of bladder tumor for bladder cancer patients was 12.50% (115/920). Lasso-Logistic regression analysis revealed that age, hypertension, diabetes, serum procalcitonin (PCT), interleukin-6 (IL-6), C-reactive protein (CRP), peripheral blood CD3+, CD4+/CD8+, immunoglobulin A (IgA), immunoglobulin M (IgM), urine matrix metalloproteinase-7 (MMP-7), surfactant protein A (SP-A), and surfactant protein D (SP-D) were independent influencing factors for postoperative UTI in bladder cancer patients (P < 0.05). The Lasso-Logistic prediction model was constructed based on above factors: Logit(P)=-2.516+1.109×age+1.002×diabetes+1.359×hypertension+1.496×CRP+1.726×PCT+1.562×IL-6-1.155×CD3+-1.280×CD4+/CD8+-1.032×IgA-1.411×IgM+1.589×MMP-7-0.843×SP-A-0.799×SP-D. The ROC curve analysis showed that the area under the curve (AUC) of the model for predicting postoperative UTI in bladder cancer patients was 0.944 (95%CI, 0.927 to 0.958), with sensitivity and specificity of 87.83% and 85.22% respectively. DCA results indicated that the model had significant positive net benefits.
    Conclusion The incidence of UTI after transurethral resection of bladder tumor in bladder cancer patients is relatively high. The construction of a Lasso-Logistic prediction model based on influencing factors can provide a reliable reference for clinical prediction of UTI risk.

     

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