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      Establishment and Validation of a Risk Prediction Model for Mortality in Patients with Acinetobacter baumannii Infection: A Retrospective Study

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          Abstract

          Purpose

          This study aims to establish a valuable risk prediction model for mortality in patients with Acinetobacter baumannii ( A. baumannii).

          Patients and Methods

          The 622 patients with A. baumannii infection from the First Affiliated Hospital of Anhui Medical University were enrolled as the study cohort. Univariate and multivariate logistic regression analysis was used to preliminarily screen the independent risk factors of death caused by A. baumannii infection, followed by LASSO regression analysis to determine the risk factors. According to the calculated regression coefficient, the Nomogram death prediction model is established. The area under the curve (AUC) and decision curve analysis (DCA) of the operating characteristic (ROC) curve of the subjects are used to evaluate the discrimination of the established prediction model. The calibration degree of the prediction model is represented by a calibration chart. A validation cohort that consisted of 477 patients admitted to the 901st Hospital was also included.

          Results

          Our results revealed that the source of infection, carbapenem-resistant A. baumannii, mechanical ventilation, serum albumin value, and Charlson comorbidity index were independent risk factors for death caused by A. baumannii infection. The AUC value of ROC curves of study cohort and validation cohort were 0.76 and 0.69, respectively. The probability range (30–80%) indicated a high net income of the modified model and strong capacity of discrimination. The calibration curve obtained by analysis swings up and down around the 45 diagonal line, which shows that the calibration degree of the prediction model is very high.

          Conclusion

          In this study, we have reconstructed a risk prediction model for mortality in patients with A. baumannii infections. This model provides useful information to predict the risk of death in patients with A. baumannii infection, but the specificity is not optimistic. If this prediction model is wanted to be applied to clinical practice, more analysis and research are necessary.

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          Most cited references28

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          A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation

          The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.
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            CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting.

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              Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD): the TRIPOD Statement.

              Prediction models are developed to aid healthcare providers in estimating the probability or risk that a specific disease or condition is present (diagnostic models) or that a specific event will occur in the future (prognostic models), to inform their decision-making. However, the overwhelming evidence shows that the quality of reporting of prediction model studies is poor. Only with full and clear reporting of information on all aspects of a prediction model can risk of bias and potential usefulness of prediction models be adequately assessed. The Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) Initiative developed a set of recommendations for the reporting of studies developing, validating or updating a prediction model, whether for diagnostic or prognostic purposes. This article describes how the TRIPOD Statement was developed.
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                Author and article information

                Journal
                Infect Drug Resist
                Infect Drug Resist
                idr
                Infection and Drug Resistance
                Dove
                1178-6973
                27 December 2023
                2023
                : 16
                : 7855-7866
                Affiliations
                [1 ]Department of Infectious Disease, the First Affiliated Hospital of Anhui Medical University , Hefei, Anhui, People’s Republic of China
                [2 ]Department of Infectious Disease, the 901st Hospital , Hefei, Anhui, People’s Republic of China
                [3 ]Department of Clinical Laboratory, the 901st Hospital , Hefei, Anhui, People’s Republic of China
                [4 ]Anhui Center for Surveillance of Bacterial Resistance , Hefei, Anhui, People’s Republic of China
                [5 ]Institute of Bacterial Resistance, Anhui Medical University , Hefei, Anhui, People’s Republic of China
                [6 ]Department of Infectious Diseases, the Chaohu Affiliated Hospital of Anhui Medical University , Hefei, Anhui, People’s Republic of China
                Author notes
                Correspondence: Ying Ye; Jiabin Li, Tel +86-551-62922713, Fax +86-551-62922281, Email yeying2@139.com; lijiabin@ahmu.edu.cn
                Author information
                http://orcid.org/0009-0008-6181-8953
                http://orcid.org/0000-0002-5224-773X
                Article
                423969
                10.2147/IDR.S423969
                10757776
                5296979d-b19a-4268-a2ce-81213157421d
                © 2023 Song et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 05 June 2023
                : 24 October 2023
                Page count
                Figures: 6, Tables: 4, References: 28, Pages: 12
                Funding
                Funded by: Scientific Research Project of Anhui Provincial Health Committee;
                Funded by: National Natural Science Foundation of China, open-funder-registry 10.13039/501100001809;
                This study was supported by the Scientific Research Project of Anhui Provincial Health Committee (No. AHWJ 2021b096), the National Natural Science Foundation of China (No. 81973983).
                Categories
                Original Research

                Infectious disease & Microbiology
                a. baumannii,prediction model,risk factors,carbapenem resistance

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