Analysis of the related factors of nosocomial infection in patients with non-surgical basal ganglia intracranial hemorrhage in acute phase / 中国医师进修杂志

ABSTRACT

Objective To assess the risk factors associated with nosocomial infection in patients with non-surgical basal ganglia intracranial hemorrhage (ICH) in the acute phase to provide evidence for prevention and intervention of nosocomial infections.Methods Clinical data of 224 patients with nonsurgical basal ganglia ICH from January 2014 to December 2018 in the Shenzhen People's Hospital were analyzed.Patients were divided into 2 groups based on the presence or absence of infection.Clinical data between the two groups were compared including gender,age,past medical history,bleeding volume,hematoma growth rate,systolic blood pressure,diastolic blood pressure,GCS,NIHSS,WBC,RBC,FBI,PLT,CR,BUN,GLU,CRP,UA,CHOL,TG,LDL,HCY.Multivariate Logistic regression analysis and the area under the ROC curve were performed on meaningful variables (P ＜ 0.05) to determine the early independent predictors of risk factors for nosocomial infections.ResuIts Nosocomial infection occurred in 47 of 224 patients,with an infection rate of 20.98％.Compared with infected group,non-infected group had a higher value of age [(63.91 ± 12.37) years vs.(58.66 ± 12.37) years,P =0.010],bleeding volume [(10.33 ± 7.94) ml vs.(7.61 ± 6.58) ml,P=0.034],hematoma growth rate [(7.34 ± 9.17) ml/h vs.(4.33 ± 6.77) ml/h,P=0.040],systolic blood pressure [(177.94 ± 25.28) mmHg (1 mmHg=0.133 kPa)vs.(164.85 ± 22.34) mmHg,P=0.001],NIHSS score [(7.89 ± 4.92) scores vs.(4.84 ± 4.59) scores,P＜0.01],WBC [(9.50 ± 3.23) × 109/L vs.(8.25 ± 2.28) × 109/L,p=0.015],FBI [(3.44 ± 0.95) g/L vs.(3.03 ± 0.63) g/L,P =0.007],BUN [(7.01 ± 5.84) mmol/L vs.(4.95 ± 1.93) mmol/L,P =0.021],GLU [(7.27 ± 2.84) mmol/L vs.(5.96 ± 1.75),P =0.004] and CRP [(11.94 ± 21.4) mg/L vs.(4.39 ± 6.41) mg/L,P=0.021].Multivariate Logistic regression analysis showed that systolic blood pressure (OR=1.021,95％ CI 1.005-1.037,P=0.012),NIHSS score (OR=1.143,95％ CI 1.056-1.237,P=0.001),BUN (OR=1.174,95％ CI 1.025-1.344,P=0.020),CRP (OR=1.063,95％ CI 1.016-1.112,P=0.008) and age (OR=1.053,95％CI 1.019-1.089,P=0.002) was an independent risk factor for nosocomial infection in non-surgical basal ganglia ICH patients in the acute phase.The Area Under Curve (AUC) of the above independent risk factors was calculated,and the results showed that systolic blood pressure (AUC =0.653,95％ CI 0.564-0.741,P =0.001),NIHSS score (AUC =0.679,95％ CI 0.592-0.767,P =0.000),BUN (AUC =0.617,95％ CI 0.526-0.708,P =0.014),CRP (AUC =0.691,95％ CI 0.614-0.768,P =0.000) and age (AUC =0.643,95％ CI 0.557-0.728,P =0.003) had an early predictive value for the occurrence of nosocomial infection in non-operative basal ganglia ICH patients in the acute stage.Conclusions The occurrence of nosocomial infections has identifiable and early predictive risk factors in patients with non-surgical basal ganglia ICH during acute phase.Therefore,controllable risk factors need to be controlled to reduce the incidence of nosocomial infections.