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Li Y, Gao X, Diao H, Shi T, Zhang J, Liu Y, Zeng Q, Ding J, Chen J, Yang K, Ma Q, Liu X, Yu H, Lu G. Development and application of a risk nomogram for the prediction of risk of carbapenem-resistant Acinetobacter baumannii infections in neuro-intensive care unit: a mixed method study. Antimicrob Resist Infect Control 2024; 13:62. [PMID: 38867312 PMCID: PMC11170918 DOI: 10.1186/s13756-024-01420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 06/04/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVE This study aimed to develop and apply a nomogram with good accuracy to predict the risk of CRAB infections in neuro-critically ill patients. In addition, the difficulties and expectations of application such a tool in clinical practice was investigated. METHODS A mixed methods sequential explanatory study design was utilized. We first conducted a retrospective study to identify the risk factors for the development of CRAB infections in neuro-critically ill patients; and further develop and validate a nomogram predictive model. Then, based on the developed predictive tool, medical staff in the neuro-ICU were received an in-depth interview to investigate their opinions and barriers in using the prediction tool during clinical practice. The model development and validation is carried out by R. The transcripts of the interviews were analyzed by Maxqda. RESULTS In our cohort, the occurrence of CRAB infections was 8.63% (47/544). Multivariate regression analysis showed that the length of neuro-ICU stay, male, diabetes, low red blood cell (RBC) count, high levels of procalcitonin (PCT), and number of antibiotics ≥ 2 were independent risk factors for CRAB infections in neuro-ICU patients. Our nomogram model demonstrated a good calibration and discrimination in both training and validation sets, with AUC values of 0.816 and 0.875. Additionally, the model demonstrated good clinical utility. The significant barriers identified in the interview include "skepticism about the accuracy of the model", "delay in early prediction by the indicator of length of neuro-ICU stay", and "lack of a proper protocol for clinical application". CONCLUSIONS We established and validated a nomogram incorporating six easily accessed indicators during clinical practice (the length of neuro-ICU stay, male, diabetes, RBC, PCT level, and the number of antibiotics used) to predict the risk of CRAB infections in neuro-ICU patients. Medical staff are generally interested in using the tool to predict the risk of CRAB, however delivering clinical prediction tools in routine clinical practice remains challenging.
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Affiliation(s)
- Yuping Li
- School of Public Health, Yangzhou University, Yangzhou, 225009, China
- School of Nursing, Yangzhou University, Yangzhou, 225009, China
- Jiangsu Key Laboratory of Zoonosis, Yangzhou, 225009, China
| | - Xianru Gao
- School of Nursing, Yangzhou University, Yangzhou, 225009, China
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China
| | - Haiqing Diao
- School of Nursing, Yangzhou University, Yangzhou, 225009, China
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China
| | - Tian Shi
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China
| | - Jingyue Zhang
- School of Nursing, Yangzhou University, Yangzhou, 225009, China
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China
| | - Yuting Liu
- School of Nursing, Yangzhou University, Yangzhou, 225009, China
| | - Qingping Zeng
- School of Nursing, Yangzhou University, Yangzhou, 225009, China
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China
| | - JiaLi Ding
- School of Nursing, Yangzhou University, Yangzhou, 225009, China
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China
| | - Juan Chen
- School of Nursing, Yangzhou University, Yangzhou, 225009, China
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China
| | - Kai Yang
- School of Artificial Intelligence, School of Information Engineering, Yangzhou, 225009, China
| | - Qiang Ma
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China
| | - Xiaoguang Liu
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China
| | - Hailong Yu
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Guangyu Lu
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China.
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 225001, China.
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Lu G, Zhang J, Shi T, Liu Y, Gao X, Zeng Q, Ding J, Chen J, Yang K, Ma Q, Liu X, Ren C, Yu H, Li Y. Development and application of a nomogram model for the prediction of carbapenem-resistant Klebsiella pneumoniae infection in neuro-ICU patients. Microbiol Spectr 2024; 12:e0309623. [PMID: 38059625 PMCID: PMC10782973 DOI: 10.1128/spectrum.03096-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/09/2023] [Indexed: 12/08/2023] Open
Abstract
IMPORTANCE Patients in neuro-ICU are at a high risk of developing nosocomial CRKP infection owing to complex conditions, critical illness, and frequent invasive procedures. However, studies focused on constructing prediction models for assessing the risk of CRKP infection in neurocritically ill patients are lacking at present. Therefore, this study aims to establish a simple-to-use nomogram for predicting the risk of CRKP infection in patients admitted to the neuro-ICU. Three easily accessed variables were included in the model, including the number of antibiotics used, surgery, and the length of neuro-ICU stay. This nomogram might serve as a useful tool to facilitate early detection and reduction of the CRKP infection risk of neurocritically ill patients.
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Affiliation(s)
- Guangyu Lu
- School of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Jingyue Zhang
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Tian Shi
- Neuro-Intensive Care Unit, Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Yuting Liu
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Xianru Gao
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Qingping Zeng
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Jiali Ding
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Juan Chen
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Kai Yang
- College of Information Engineering, Yangzhou University, Yangzhou, China
| | - Qiang Ma
- Neuro-Intensive Care Unit, Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Xiaoguang Liu
- Neuro-Intensive Care Unit, Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Chuanli Ren
- Department of Laboratory Medicine, Clinical College of Yangzhou University, Yangzhou, China
| | - Hailong Yu
- Department of Neurology, Northern Jiangsu People’s Hospital, Yangzhou, China
- Department of Neuro-Intensive Care Unit, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Yuping Li
- Neuro-Intensive Care Unit, Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
- Department of Neuro-Intensive Care Unit, Clinical Medical College of Yangzhou University, Yangzhou, China
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Li Y, Liu Y, Huang Y, Zhang J, Ma Q, Liu X, Chen Q, Yu H, Dong L, Lu G. Development and validation of a user-friendly risk nomogram for the prediction of catheter-associated urinary tract infection in neuro-intensive care patients. Intensive Crit Care Nurs 2023; 74:103329. [PMID: 36192313 DOI: 10.1016/j.iccn.2022.103329] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aimed to develop a user-friendly nomogram model to evaluate the risk of catheter-associated urinary tract infections in neuro-critically ill patients. METHODS A retrospective cohort analysis was conducted on 537 patients with indwelling catheters admitted to the neuro-intensive care unit. Patients' general information, laboratory examination findings, and clinical characteristics were collected. Multivariate regression analysis was applied to develop the nomogram for the prediction of catheter-associated urinary tract infections in this group of patients. The discriminative capacity, calibration ability, and clinical effectiveness of the nomogram were evaluated. RESULTS The occurrence of catheter-associated urinary tract infections was 3.91 % and Escherichia coli was the major causative pathogen. Multivariate regression analysis showed that age ≥ 60 years (odds ratio: 35.2, 95 % confidence interval: 2.3-550.8), epilepsy (39.3, 5.1-301.4), a length of neuro-intensive care stay > 30 days (272.2, 8.3-8963.5), and low albumin levels (<35 g/L) (12.1, 2.1-69.9) were independent risk factors associated with catheter-associated urinary tract infection in neuro-intensive care patients. The nomogram demonstrated good calibration and discrimination in both the training and the validation sets. The model exhibited good clinical use since the decision curve analysis covered a large threshold probability. CONCLUSIONS We developed a user-friendly nomogram to predict catheter-associated urinary tract ibfection in neuro-intensive care patients. The nomogram incorporated clinical variables collected on admission (age, admission diagnosis, and albumin levels) and the length of stay and enabled the effective prediction of the likelihood of catheter-associated urinary tract infections.
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Affiliation(s)
- Yuping Li
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, China; Clinical Medical College of Yangzhou University, Yangzhou 225009, China
| | - Yuting Liu
- School of Nursing, Yangzhou University, Yangzhou 225009, China
| | - Yujia Huang
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, China; Clinical Medical College of Yangzhou University, Yangzhou 225009, China
| | - Jingyue Zhang
- School of Nursing, Yangzhou University, Yangzhou 225009, China
| | - Qiang Ma
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, China
| | - Xiaoguang Liu
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, China
| | - Qi Chen
- School of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou 225009, China
| | - Hailong Yu
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, China
| | - Lun Dong
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, China
| | - Guangyu Lu
- School of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou 225009, China.
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Wen J, Chen J, Chang J, Wei J. Pulmonary complications and respiratory management in neurocritical care: a narrative review. Chin Med J (Engl) 2022; 135:779-789. [PMID: 35671179 PMCID: PMC9276382 DOI: 10.1097/cm9.0000000000001930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Neurocritical care (NCC) is not only generally guided by principles of general intensive care, but also directed by specific goals and methods. This review summarizes the common pulmonary diseases and pathophysiology affecting NCC patients and the progress made in strategies of respiratory support in NCC. This review highlights the possible interactions and pathways that have been revealed between neurological injuries and respiratory diseases, including the catecholamine pathway, systemic inflammatory reactions, adrenergic hypersensitivity, and dopaminergic signaling. Pulmonary complications of neurocritical patients include pneumonia, neurological pulmonary edema, and respiratory distress. Specific aspects of respiratory management include prioritizing the protection of the brain, and the goal of respiratory management is to avoid inappropriate blood gas composition levels and intracranial hypertension. Compared with the traditional mode of protective mechanical ventilation with low tidal volume (Vt), high positive end-expiratory pressure (PEEP), and recruitment maneuvers, low PEEP might yield a potential benefit in closing and protecting the lung tissue. Multimodal neuromonitoring can ensure the safety of respiratory maneuvers in clinical and scientific practice. Future studies are required to develop guidelines for respiratory management in NCC.
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Affiliation(s)
- Junxian Wen
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Dongcheng District, Beijing 100730, China
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Wei J, Jiang R, Li L, Kang D, Gao G, You C, Zhang J, Gao L, Huang Q, Luo D, Zhao G, Zhang H, Wang S, Wang R. Stress-related upper gastrointestinal bleeding in adult neurocritical care patients: a Chinese multicenter, retrospective study. Curr Med Res Opin 2019; 35:181-187. [PMID: 29499622 DOI: 10.1080/03007995.2018.1448261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE China has limited data on stress-related gastrointestinal ulcers in patients admitted for neurosurgical care. This study evaluated the incidence of upper gastrointestinal bleeding (UGIB) and use of stress ulcer prophylaxis (SUP) in Chinese neurocritical care patients (Glasgow Coma Scale [GCS] score ≤10). METHODS This multicenter, retrospective study was performed from January 2015 to July 2015. Medical records of 1468 patients hospitalized during 2014 were reviewed. An estimated UGIB incidence rate of 4.4% was considered for precision of 1.3% for estimation of UGIB. The primary endpoint was evaluation of overall incidence of any overt UGIB in ≤14 days after cerebral lesion. Secondary endpoints included incidence of UGIB with or and without clinically significant complications, time to UGIB, associated risk factors and SUP used. RESULTS We analyzed 1416 patients (mean age: 53.7 ± 14.00 years; males: 62.4%) with cerebral lesions. Overall incidence rate of UGIB ≤14 days was 12.9% (95% CI: 11.2%-14.7%), 0.76% with and 12.1% without significant clinical complications. Average time and duration of bleeding were 2.9 ± 3.37 days and 4.2 ± 8.4 days, respectively. The most significant risk factors for UGIB were mechanical ventilation for >48 hours (p < .0001), UGIB history (p = .0026) and use of anticoagulants (p < .0001). Acid-suppression drugs were administered for SUP in 79.0% of the patients, whereas 40.5% received hemostatic drugs. CONCLUSIONS The rate of UGIB incidence was higher than the estimated rate in neurocritical care patients in China, suggesting the need for better management and treatment for stress-related mucosal disease in China. History of UGIB, mechanical ventilation and/or anticoagulants significantly affected UGIB. ClinicalTrials registry number: NCT02316990.
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Affiliation(s)
- Junji Wei
- a Department of Neurosurgery , Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College , Beijing , China
| | - Rongcai Jiang
- b Department of Neurosurgery , Tianjin Medical University General Hospital , Tianjin , China
| | - Lihong Li
- c Department of Neurosurgery , Tangdu Hospital of the Fourth Military Medical University , Xi'an , China
| | - Dezhi Kang
- d Department of Neurosurgery , the First Affiliated Hospital of Fujian Medical University , Fuzhou , China
| | - Guodong Gao
- c Department of Neurosurgery , Tangdu Hospital of the Fourth Military Medical University , Xi'an , China
| | - Chao You
- e Department of Neurosurgery, West China School of Medicine/West China Hospital , Sichuan University , Chengdu , China
| | - Jianmin Zhang
- f Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University School of Medicine , Hangzhou , China
| | - Liang Gao
- g Department of Neurosurgery , Shanghai Tenth People's Hospital/Tenth People's Hospital of Tongji University , Shanghai , China
| | - Qibing Huang
- h Department of Neurosurgery , Qilu Hospital of Shandong University , Jinan , China
| | - Duanwu Luo
- i Department of Neurosurgery , Xiangya Hospital Central South University , Changsha , China
| | - Gang Zhao
- j Department of Neurosurgery , the First Hospital of Jilin University , Changchun , China
| | - Hongyi Zhang
- k Department of Neurosurgery , Tangshan Gongren Hospital , Tangshan , China
| | - Shuo Wang
- l Department of Neurosurgery , Beijing Tian Tan Hospital, Capital Medical University , Beijing , China
| | - Renzhi Wang
- a Department of Neurosurgery , Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College , Beijing , China
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