Objective To analyze the influencing factors of catheter-related bloodstream infection (CRBSI) in patients with chronic renal failure (CRF) undergoing hemodialysis and to construct a nomogram prediction model.
Methods A total of 120 CRF patients undergoing hemodialysis were selected as study subjects. The patients were divided into CRBSI group (n=19) and non-CRBSI group (n=101) based on whether CRBSI occurred. Clinical data and levels of biological markers peripheral blood albumin (ALB), serum procalcitonin (PCT), tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), transforming growth factor-β1 (TGF-β1) and Smad indicators (Smad2 and Smad3) were compared between the two groups. Factors influencing the occurrence of CRBSI in CRF patients undergoing hemodialysis were analyzed. A nomogram prediction model for CRBSI in CRF hemodialysis patients was constructed based on these influencing factors and validated using receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA).
Results Among the 120 CRF patients undergoing hemodialysis, 19 developed CRBSI, with an incidence rate of 15.83%. The CRBSI group had significantly higher levels of age, smoking prevalence, diabetes mellitus comorbidity, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, serum PCT, TNF-α, IL-8, TGF-β1, Smad2 as well as Smad3, and significantly lower peripheral blood ALB levels compared to the non-CRBSI group (P < 0.05). The number of catheter insertions and duration of catheter placement were also significantly higher or shorter in the CRBSI group than in the non-CRBSI group (P < 0.05). Logistic regression analysis showed that smoking, age, duration of catheter placement, the number of catheter insertions, APACHE Ⅱ score, diabetes mellitus comorbidity, PCT, IL-8, ALB, TGF-β1, Smad2, TNF-α and Smad3 were influencing factors for CRBSI in CRF patients undergoing hemodialysis (P < 0.05). Forest plot results indicated that age, smoking, the number of catheter insertions, duration of catheter placement, diabetes mellitus comorbidity, APACHE Ⅱ score, PCT, TNF-α, IL-8, TGF-β1, Smad2 and Smad3 levels were positive factors, while ALB level was negative factor (P < 0.05). ROC curve, calibration curve, and DCA demonstrated that the constructed nomogram prediction model for CRBSI risk in CRF hemodialysis patients had good consistency and predictive efficacy.
Conclusion Age, the number of catheter insertions, smoking, duration of catheter placement, APACHE Ⅱ score, PCT, diabetes mellitus comorbidity, ALB, TNF-α, TGF-β1, Smad2, IL-8 and Smad3 are influencing factors for CRBSI in CRF patients with hemodialysis. A nomogram prediction model based on these factors has good predictive value.
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