耐甲氧西林金黄色葡萄球菌感染风险预测模型的系统评价

Systematic evaluation of risk prediction model for methicillin-resistant Staphylococcus aureus infection

  • 摘要:
    目的 在数据库中检索住院患者耐甲氧西林金黄色葡萄球菌(MRSA)感染风险预测模型相关文献并对预测模型进行评价。
    方法 检索PubMed、Embase、Scopus、Cochrane library数据库和中国知网、万方数据知识服务平台、维普数据库中的住院患者MRSA感染风险预测模型相关文献,时间范围为建库至2024年1月1日。2名研究者独立进行文献筛查和资料提取,并应用预测模型偏倚风险评估工具(PROBAST)评估文献中预测模型的偏倚风险和适用性,进行描述性分析。
    结果 本研究最终纳入12篇文献(共15个预测模型),各文献的研究总样本量、MRSA感染事件数、建模样本量、验模样本量差异较大。预测模型中常见的预测因子为入住重症监护室、使用抗生素、护理机构居住史、年龄、慢性肾病和既往住院史。9篇文献进行内部验证, 3篇文献进行内部验证和外部验证; 9篇文献报告了受试者工作特征曲线的曲线下面积,仅3篇文献基于Hosmer-Lemeshow检验报告了模型的校准度。PROBAST分析结果显示, 10篇文献的模型被评估为高偏倚风险,主要来源于统计分析方面。
    结论 现有文献中的大多数MRSA感染风险预测模型对MRSA感染的预测效能较好,但总体偏倚风险较高,且仅有少数模型进行外部验证。研究者未来应遵循PROBAST标准构建模型并进行外部验证,以开发适用于临床实践的模型。

     

    Abstract:
    Objective To retrieve relevant literature on risk prediction model for methicillin-resistant Staphylococcus aureus (MRSA) infection among hospitalized patients from databases and evaluate the predictive model.
    Methods The literature on risk prediction models for MRSA infection among hospitalized patients was retrieved from PubMed, Embase, Scopus, Cochrane library, China National Knowledge Infrastructure (CNKI), WanFang data, and VIP database, with a time range from the inception of the database to January 1, 2024. Two researchers independently screened the literature, extracted data. The Prediction Model Risk of Bias Assessment Tool (PROBAST) was applied to evaluate the risk of bias and applicability of the prediction model in the literature, and descriptive analysis was conducted.
    Results A total of 12 articles (15 prediction models) were included in this study, with significant differences in the total sample size, the number of MRSA infection events, sample size of modeling, and sample size of validation among the studies. Common predictors in the prediction models were admission to the intensive care unit, antibiotic use, history of residence in nursing facilities, age, chronic kidney disease, and previous hospitalization history. Nine articles conducted internal validation, and three articles conducted both internal and external validation. Nine articles reported the area under the receiver operating characteristic curve, and only three articles reported the calibration of the model based on the Hosmer-Lemeshow test. PROBAST analysis showed that 10 articles were assessed as high risk bias, mainly stemming from statistical analysis.
    Conclusion Most of the MRSA infection risk prediction models in the current literature have good predictive efficacy for MRSA infection, but they all have higher overall risk of bias, and only a few models have undergone external validation. Researchers should follow PROBAST standards to construct and externally validate models in the future so as to develop models suitable for clinical practice.

     

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