Establishment and validation of a risk prediction model for primary liver cancer complicated with pulmonary infection before intervention

doi:10.11958/20240147

Abstract

Abstract:

Objective To analyze the influencing factors of pulmonary infection in patients with primary liver cancer (PHC) before intervention, and establish a nomogram risk prediction model to verify it. Methods A total of 1 635 patients with PHC diagnosed and hospitalized for the first time were selected and divided into the infected group (197 cases) and the non-infected group (1 438 cases) according to whether they had pulmonary infection. General data such as body mass index (BMI), chronic hepatitis B (CHB), chronic hepatitis C (CHC), Barcelona stage (BCLC), white blood cells (WBC), neutrophils (NEU), hemoglobin (Hb) and other blood routine indicators were collected. Total protein (TP), prealbumin (PA), aspartate aminotransferase (AST), gamma glutamylaminotransferase (GGT), alkaline phospholipase (ALP), abnormal prothrombin (PIVKA-Ⅱ), alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), procalcitonin (PCT), hypersensitive C-reactive protein (hs-CRP), cholinesterase (ChE), total cholesterol (TC) and other blood biochemical indicators, CD3 cell count (CD3⁺), CD4 cell count (CD4⁺), CD4/CD8 ratio (CD4⁺/CD8⁺), CD19 cell count (CD19⁺), interleukin (IL)-2, interferon (IFN)-α, tumor necrosis factor (TNF)-α and other cytokines were also collected. Univariate analysis and Lasso regression were used to screen variables, and binary Logistic regression analysis was used to determine risk factors for pulmonary infection in PHC patients before intervention. The risk prediction model was established and evaluated. Results Compared with the non-infected group, age, smoking rate, CHC, pleural effusion, gastrointestinal hemorrhage, Child-Pugh grade C, BCLC Phase A /C /D ratio, WBC, NEU, AST, GGT, ALP, PIVKA-Ⅱ, AFP, CEA, PCT, hs-CRP, IL-2, IL-5, IL-6, IL-8, IL-10, IL-12, IFN-γ and TNF-α levels were higher in the infected group, and levels of BMI, CHB ratio, Hb, TP, PA, ChE, TC, CD3⁺, CD4⁺, CD4⁺/CD8⁺, CD19⁺ and IFN-α were lower (P < 0.05). Lasso regression and binary Logistic regression analysis showed that pleural effusion, gastrointestinal hemorrhage, higher level of age, WBC, Hb and lower level of TP were independent risk factors for pulmonary infection in patients with PHC before intervention. The area under receiver operating curve (ROC) of the established nomogram model was 0.700（95%CI:0.659-0.740), and Hosmer-Lemeshow test results showed good goodness-fit of the model. Self-sampling was repeated 1 000 times for internal verification. The consistency of the model was good. Conclusion Pleural effusion, gastrointestinal hemorrhage, higher level of age, WBC, Hb and lower level of TP are independent risk factors for pulmonary infection in PHC patients before intervention. The established nomogram prediction model can effectively evaluate the risk of pulmonary infection in PHC patients before intervention.

Key words: liver neoplasms, risk factors, Logistic models, nomograms, pulmonary infection

CLC Number:

R735.7

Figures/Tables 11

References 24

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组别	n	男性		年龄/岁		BMI/（kg/m²）		饮酒		吸烟	CHB		CHC
非感染组	1 438	1 226（85.3）		54.70±10.63		22.67±3.25		685（47.6）		769（53.5）	1 028（71.5）		279（19.4）
感染组	197	172（87.3）		56.98±10.86		22.11±2.84		106（53.8）		125（63.5）	123（62.4）		51（25.9）
χ²或t		0.589		2.812^＊＊		2.311^＊		2.642		6.956^＊＊	6.812^＊＊		4.525^＊
组别	高血压		糖尿病		胸腔积液		胃肠道出血		Child-Pugh分级（A/B/C）			BCLC分期（0/A/B/C/D）
非感染组	252（17.5）		208（14.5）		96（6.7）		72（5.0）		584/563/291			440/45/542/136/275
感染组	31（15.7）		37（18.8）		47（23.9）		22（11.2）		45/73/79			34/9/51/31/72
χ²	0.387		2.535		64.089^＊＊		12.135^＊＊		44.630^＊＊			49.849^＊＊

组别	n	男性		年龄/岁		BMI/（kg/m²）		饮酒		吸烟	CHB		CHC
非感染组	1 438	1 226（85.3）		54.70±10.63		22.67±3.25		685（47.6）		769（53.5）	1 028（71.5）		279（19.4）
感染组	197	172（87.3）		56.98±10.86		22.11±2.84		106（53.8）		125（63.5）	123（62.4）		51（25.9）
χ²或t		0.589		2.812^＊＊		2.311^＊		2.642		6.956^＊＊	6.812^＊＊		4.525^＊
组别	高血压		糖尿病		胸腔积液		胃肠道出血		Child-Pugh分级（A/B/C）			BCLC分期（0/A/B/C/D）
非感染组	252（17.5）		208（14.5）		96（6.7）		72（5.0）		584/563/291			440/45/542/136/275
感染组	31（15.7）		37（18.8）		47（23.9）		22（11.2）		45/73/79			34/9/51/31/72
χ²	0.387		2.535		64.089^＊＊		12.135^＊＊		44.630^＊＊			49.849^＊＊

组别	n	WBC/（×10⁹/L）	NEU/（×10⁹/L）	Hb/（g/L）	PLT/（×10⁹/L）	FIB/（g/L）
非感染组	1 438	4.83（3.56，6.44）	3.00（2.09，4.42）	131.75±31.43	108.00（73.00，165.00）	2.74（2.06，3.62）
感染组	197	5.84（4.21，7.87）	4.07（2.59，6.20）	126.01±29.72	114.00（67.50，194.50）	2.67（1.86，3.76）
Z或t		5.210^＊＊	6.151^＊＊	2.420^＊	0.899	0.787

组别	n	WBC/（×10⁹/L）	NEU/（×10⁹/L）	Hb/（g/L）	PLT/（×10⁹/L）	FIB/（g/L）
非感染组	1 438	4.83（3.56，6.44）	3.00（2.09，4.42）	131.75±31.43	108.00（73.00，165.00）	2.74（2.06，3.62）
感染组	197	5.84（4.21，7.87）	4.07（2.59，6.20）	126.01±29.72	114.00（67.50，194.50）	2.67（1.86，3.76）
Z或t		5.210^＊＊	6.151^＊＊	2.420^＊	0.899	0.787

组别	n		TP/（g/L）	PA/（mg/L）		AST/（U/L）		ALT/（U/L）		GGT/（U/L）		ALP/（U/L）
非感染组	1 438		66.41±8.08	116.00（76.10，175.55）		55.00（35.00，101.00）		37.00（24.00，61.00）		100.00（50.00，219.00）		151.50（110.00，228.00）
感染组	197		62.80±8.80	94.60（63.75，130.84）		70.00（39.00，119.50）		40.00（23.00，69.50）		137.00（62.00，293.50）		183.00（126.00，302.00）
Z或t			5.803^＊＊	5.263^＊＊		3.189^＊＊		0.415		2.794^＊＊		3.936^＊＊
组别			PIVKA-Ⅱ/（×10³ mAU/L）			AFP/（μg/L）		CEA/（μg/L）	PCT/（μg/L）		SAA/（mg/L）		hs-CRP/（mg/L）
非感染组			205.50（31.00，3 816.00）			23.09（4.58，717.85）		3.04（2.03，4.50）	0.16（0.07，0.36）		21.90（6.24，70.16）		7.72（1.67，26.75）
感染组			1 566.60（129.70，13 236.00）			68.73（6.62，5 147.50）		3.67（2.11，6.15）	0.29（0.12，0.78）		30.84（7.28，79.95）		20.34（7.87，51.76）
Z			5.851^＊＊			3.157^＊＊		3.259^＊＊	5.947^＊＊		1.935		6.803^＊＊
组别		ChE/（U/L）			Cr/（μmol/L）		UA/（μmol/L）		TC/（mmol/L）		TG/（mmol/L）		LDL-C/（mmol/L）
非感染组		4 011.50（2 539.25，5 992.50）			65.10（56.00，78.00）		325.00（254.00，400.25）		3.79（3.07，4.57）		1.07±0.79		2.33（1.77，3.00）
感染组		2 921.00（1 797.50，4 554.00）			67.00（57.00，87.00）		322.00（255.00，420.00）		3.54（2.79，4.53）		1.10±0.79		2.28（1.60，3.25）
Z或t		6.431^＊＊			1.944		0.677		2.455^＊		0.479		0.477