Construction and validation of prognostic nomogram for hospital-acquired CRE colonization among ICU patients based on ADASYN algorithm
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Objectives To construct a prognostic model for patients with high risk of Carbapenem-resistant Enterobacteriaceae (CRE) colonization in Intensive Care Unit (ICU). Methods A prospective cohort study was performed on 724 ICU patients from Mar 2023 to Jul 2024 at a tertiary hospital. Totally 577 patients were involved by selection and divided into the modeling (n=392) and validation (n=185) cohorts. Multivariate analysis based on adaptive synthetic sampling (ADASYN) was conducted to estimate the risk of CRE colonization, then presented with a visible nomogram. Next, the performances of nomogram were assessed by area under the receiver operating characteristic curve (AUROC), calibration curves, decision curve analysis (DCA), clinical impact curve (CIC). Results The incidence rate of CRE colonization was 10.05% among ICU patients. Multivariate analysis showed Enterobacteriaceae infection (D), days of carbapenem antibiotics (X 1 ) and mechanical ventilation (X 2 ) were independent risk factors of CRE colonization. Logistic regressions based on original data and ADASYN algorithm were described as follows: Logit( P 1 )=1.824D 1 +21.604D 2 +2.482X 1 +1.088X 2 -8.039 and Logit( P 2 )=2.754D 1 +24.355D 2 +2.824X 1 +1.577X 2 -7.057. Internal validation showed ADASYN algorithm model has a higher goodness-of-fit compared with original data model without reducing the discrimination ( P =0.818). DCA of ADASYN algorithm model indicated the threshold risk of positive net benefit ranged 0 to 75%. CIC analysis verified ADASYN algorithm model possessed significant predictive value. A well discrimination with AUROC value of 0.891 (95%CI:0.786~0.995) and goodness-of-fit ( P =0.197) was demonstrated by external validation. Conclusions ADASYN algorithm model can identify patients with high risk of CRE colonization. Optimizing the usage of carbapenem and mechanical ventilation may reduce the risk of CRE colonization.
