Establishment Of A Risk Scoring System For Central Line-Associated Bloodstream Infection

Background:In recent years,with central venous catheter(CVC)widely used in hemodynamics monitoring,hemodialysis,drainage of the chest or abdominal cavity or pericardial effusion,establishment of long-term infusion pathways,and so on,CVC related complications such as thrombosis,air embolism,infection,vascular injury and others are also increasing.Central line-associated bloodstream infection(CLABSI)is one of the most important complications,which often results in the spread of systemic infection,causing the failure of single or multiple important organ functions,significantly increasing the length of hospital stay,medical expenses,unexpected extubation and mortality.Scientific evaluation on patients in future possibility of CLABSI before catheter indwelling,it is of great clinical significance in helping operators decide to whether indwell venous catheter,what target preventive measures should be taken,and how to find CLABSI out early.Although multiple independent risk factors of CLABSI have been found in previous studies,there is no a simple,effective and intuitive risk scoring system to assess the risk of CLABSI when multiple risk factors coexist.While the coexistence of multiple risk factors in the clinical practice is very common.Therefore,it is urgent necessary and has broad application prospects to explore and establish an effective risk scoring system for predicting CLABSI.Objective:Screening the independent risk factors and establishing a risk scoring system of CLABSI,to provide a comprehensive evaluation assessment tool forV predicting the possibility of CLABSI and assessing the risk benefit ratio of CVC catheterization before CVC placement.Material and methods:1.Literature screening: Firstly,the inclusion and exclusion criteria were formulated.The literature on the risk factors related to CLABSI was retrieved according to the search strategy developed,and the literatures that met the requirements were evaluated and screened.2.The CLABSI risk factors listed in the literatures were categorized according to professional knowledge.The risk factors of significance were screened out from these factors through the method of meta-analysis and were combined according to the principle of permutation and combination in each document.The same combinations in all literature were combined and analyzed.The OR(odds ratio)value of each risk factor in the combination was denoted by the median of the corresponding OR values in the literatures.The risk factors importance were ranked according to their OR values comparion and micro adjusted combine expert opinion.Finally,the scoring criteria were established:set 1 point for the last risk factor in the importance row and graded in turn,and took ratio of the OR value between adjacent risk factors as a weight,then assigned each selected risk factor.3.Data of 460 patients with venous catheterization from the First Affiliated Hospital of Guangdong Pharmaceutical University during January 2015 to December 2017 were studied by the risk scoring system for CLABSI developed.The receiver operation characteristic curve(ROC)was drawn based on risk factor scores before and the end of catheterization.The dangerous cutoff value was identified and the effectiveness of the scoring system was evaluated.Result:Through the literature survey,26 studies were finally included in meta analysis.The risk factors of the risk scoring model including: coexistent infections,acute and severe disease,diabetes mellitus,long duration of catheterization,Catheter location,age,TPN(total parenteral nutrition),Immunosuppression,lumens.They were assigned 16,11,10,9,5,4,3,2 and2 scores respectively.The risk scoring model had good discriminative power: the AUC was 0.899(95%CI,0.831-0.968),standard error was 0.035,p<0.001.The best predictive cutting score was 43(sensitivity was 0.808,specificity was 0.919,a positive predictive value was 0.375,a negative predictive value was 0.988,and a total coincidence rate was 91.3%.when the score?43,it was a high risk group for CLABSI(OR=62.7;95%CI=20.458,192.163;p<0.001).Conclusion:The "Risk Scoring System For Central Line-Associated Bloodstream Infection" developed by combining multiple risk factors could accurately predict the occurrence risk of CLABSI.It might help an operator to objectively assess the possibility of CLABSI and make the correct decision before the catheter placement.