Establishment and Validation of a Nomogram to Predict Hospital-Acquired Infection in Elderly Patients After Cardiac Surgery

Abstract

Background: Hospital-acquired infection (HAI) after cardiac surgery is a common clinical concern associated with adverse prognosis and mortality. The objective of this study is to determine the prevalence of HAI and its associated risk factors in elderly patients following cardiac surgery and to build a nomogram as a predictive model. Methods: We developed and internally validated a predictive model from a retrospective cohort of 6405 patients aged ≥70 years, who were admitted to our hospital and underwent cardiac surgery. The primary outcome was HAI. Multivariable logistic regression analysis was used to identify independent factors significantly associated with HAI. The performance of the established nomogram was assessed by calibration, discrimination, and clinical utility. Internal validation was achieved by bootstrap sampling with 1000 repetitions to reduce the overfit bias. Results: Independent factors derived from the multivariable analysis to predict HAI were smoking, myocardial infarction, cardiopulmonary bypass use, intraoperative erythrocytes transfusion, extended preoperative hospitalization days and prolonged duration of mechanical ventilation postoperatively. The derivation model showed good discrimination, with a C-index of 0.706 [95% confidence interval 0.671-0.740], and good calibration [Hosmer-Lemeshow test P = 0.139]. Internal validation also maintained optimal discrimination and calibration. The decision curve analysis revealed that the nomogram was clinically useful. Conclusions: We developed a predictive nomogram for postoperative HAIs based on routinely available data. This predictive tool may enable clinicians to achieve better perioperative management for elderly patients undergoing cardiac surgery but still requires further external validation.

Development of a nomogram for predicting nosocomial infections among patients after cardiac valve replacement surgery

“…A previous study has shown the duration of mechanical ventilation is related to an incremented risk of infection, even moderately prolonged ventilation (24 h versus 48 h). Consistent with the finding of this study, other studies also demonstrated a strong correlation between the duration of mechanical ventilation and the risk of infection (Ailawadi et al, 2017; Atladottir et al, 2021; Gao et al, 2022; Hassoun‐Kheir et al, 2020). The data from the above studies suggest that clinical staff should comprehensively evaluate the patient's physical condition and shorten the duration of mechanical ventilation as much as possible.…”

“…Patients who have undergone cardiac surgery, including valve replacement, are prone to postoperative complications, and NIs are one of the more common ones (Gelijns et al, 2014). Poor physical condition and invasive procedures, including prolonged mechanical ventilation and cardiopulmonary bypass, are possible reasons for VHD patients' susceptibility to developing NIs (de la Varga‐Martínez et al, 2021; Gao et al, 2022).…”

A web‐based calculator combining Geriatric Nutritional Risk Index (GNRI) and Tilburg Frailty Indicator (TFI) predicts postoperative complications among young elderly patients with gastric cancer

“…Gao et al . established a nomogram for predicting infections acquired in a hospital among elderly patients after cardiac surgery to achieve better preoperative management 14 . Another study by Liu et al .…”

“…13 Gao et al established a nomogram for predicting infections acquired in a hospital among elderly patients after cardiac surgery to achieve better preoperative management. 14 Another study by Liu et al found that a nomogram to predict anastomotic leakage among elderly patients with rectal cancer had satisfactory accuracy and may benefit clinical decision making. 15 Yet, to the best of our knowledge, there are currently no such valuable tools available for predicting postoperative complications among elderly patients with gastric cancer.…”

Rates and Determinants of Hospital-Acquired Infection among ICU Patients Undergoing Cardiac Surgery in Developing Countries: Results from EMERGENCY’NGO’s Hospital in Sudan

“…Particularly in East African countries, where surveillance capacity is minimal, reducing the impact of infections remains an unsolved challenge. Moreover, despite a wide range of risk factors contributing to the occurrence of infections in critically ill patients that have been described in developed countries [ 2 , 3 , 4 , 5 ], to the best of our knowledge, little information is available on this topic in cardiac surgery ICUs in low-income settings.…”