Development and validation of a nomogram for predicting CRBSI in hemodialysis: a retrospective cohort study.

Abstract

Objectives: To develop and validate of a nomogram for predicting Catheter related bloodstream infection(CRBSI) in patients with maintenance hemodialysis.

Methods: This was a retrospective cohort study.A total of 756 patients underwent hemodialysis between January 2017 to December 2021 in purification center of the Affiliated Hospital of Changsha Central Hospital, University of South China were enrolled in this research.The demographic data, hemodialysis data, laboratory indexes of the patients were analyzed. Univariate analysis and multivariate Logistic regression were used to analyze the influencing factors of CRBSI in hemodialysis patients and a nomogram model was established.Area under the receiver operating characteristic curve(AUC) and Hosmer-Lemeshow(H-L)test were used to verify the discrimination and calibration of the model.

Results: Among the 756 hemodialysis patients,64 patients developed CRBSI, with an incidence rate of 8.5%(64/756).The results of multivariate analysis showed that combined with diabetes mellitus、dialysis age、catheter retention time、C-reactive protein and procalcitonin were independent risk factors for CRBSI in hemodialysis patients(P < 0.05).The receiver operating characteristic curve analysis showed that the AUC of the model was 0.88 and the H-L test results showed that the model had good goodness of fit(χ² = 5, P = 0.7).The internal validation of the prediction model showed an AUC of 0.82, and the H-L results showed (χ² = 11, P = 0.2), indicating that the model has a good prediction performance and high accuracy.

Conclusion: An easy-to-use nomogram for prediction of CRBSI in hemodialysis patients is well developed.This risk assessment tool can effectively identify patients at high risk of CRBSI and may be useful for optimizing catheter management.