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Construction and validation of infection risk model for patients with external ventricular drainage: a multicenter retrospective study

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Abstract

Purpose

External ventricular drainage (EVD) is a life-saving neurosurgical procedure, of which the most concerning complication is EVD-related infection (ERI). We aimed to construct and validate an ERI risk model and establish a monographic chart.

Methods

We retrospectively analyzed the adult EVD patients in four medical centers and split the data into a training and a validation set. We selected features via single-factor logistic regression and trained the ERI risk model using multi-factor logistic regression. We further evaluated the model discrimination, calibration, and clinical usefulness, with internal and external validation to assess the reproducibility and generalizability. We finally visualized the model as a nomogram and created an online calculator (dynamic nomogram).

Results

Our research enrolled 439 EVD patients and found 75 cases (17.1%) had ERI. Diabetes, drainage duration, site leakage, and other infections were independent risk factors that we used to fit the ERI risk model. The area under the receiver operating characteristic curve (AUC) and the Brier score of the model were 0.758 and 0.118, and these indicators’ values were similar when internally validated. In external validation, the model discrimination had a moderate decline, of which the AUC was 0.720. However, the Brier score was 0.114, suggesting no degradation in overall performance. Spiegelhalter’s Z-test indicated that the model had adequate calibration when validated internally or externally (P = 0.464 vs. P = 0.612). The model was transformed into a nomogram with an online calculator built, which is available through the website: https://wang-cdutcm.shinyapps.io/DynNomapp/.

Conclusions

The present study developed an infection risk model for EVD patients, which is freely accessible and may serve as a simple decision tool in the clinic.

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Acknowledgements

We acknowledge Ms. Qing Qing, who graduated from Massey University in New Zealand, for her English editorial assistance.

Funding

This research was supported by grants from the Xinglin Scholar Discipline Talents Scientific Research Promotion Plan of Chengdu University of TCM (YYZX2021047), the Chengdu High-level Key Clinical Specialty Construction Project (GSPZX2021-15), and the Foundation of Sichuan Health Commission (19PJ016).

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Author notes

  1. Peng Wang and Shuang Luo contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    Peng Wang & Yanhui Liu

  2. Department of Neurosurgery, Chengdu Fifth People’s Hospital/Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China

    Peng Wang, Shuang Luo, Shuwen Cheng & Min Gong

  3. Department of Neurosurgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China

    Jie Zhang

  4. Department of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China

    Ruofei Liang

  5. Department of Neurosurgery, Sichuan Cancer Hospital, Chengdu, Sichuan, China

    Weichao Ma

  6. West China Fourth Hospital/West China School of Public Health, Sichuan University, Chengdu, Sichuan, China

    Yaxin Li

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  1. Peng Wang
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Contributions

Peng Wang: methodology, funding acquisition, writing—original draft

Shuang Luo: formal analysis, visualization, writing—original draft

Shuwen Cheng: supervision, data curation, investigation

Min Gong: data curation, investigation

Jie Zhang: data curation, investigation

Ruofei Liang: data curation, investigation

Weichao Ma: data curation, investigation

Yaxin Li: formal analysis

Yanhui Liu: conceptualization, validation, writing—review and editing

Corresponding author

Correspondence to Yanhui Liu.

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Ethics approval and consent to participate

All procedures performed in this study were following the standards of the Chengdu Fifth People’s Hospital Ethical Committee (ref. no. 2019–074) and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was waived since data were anonymized.

Competing interests

The authors declare no competing interests.

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Wang, P., Luo, S., Cheng, S. et al. Construction and validation of infection risk model for patients with external ventricular drainage: a multicenter retrospective study. Acta Neurochir 165, 3255–3266 (2023). https://doi.org/10.1007/s00701-023-05771-8

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