基于术后24 h内客观护理指标构建肝移植术后感染风险简易评分模型，并探讨其在分级护理策略中的应用价值。

回顾性分析2021年1月至2023年12月中山大学孙逸仙纪念医院156例接受同种异体肝移植术受者的临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男133例，女23例；年龄18~74岁，中位年龄52岁。采用Lasso回归筛选肝移植术后早期关键特征指标，通过多因素Logistic回归构建术后早期感染预测模型并转化为术后感染简易评分。采用ROC曲线分析及Bootstrap内部验证评价模型效能，并基于截断值制定分层护理策略。

肝移植术后早期感染60例，感染发生率为38.5%（60/156）。Lasso回归筛选出标准化系数排名前4位的变量依次为术后第1天（POD1）引流液量、POD1-WBC、术中输血总量及BMI，阈值分别为POD1引流液量≥600 ml、POD1-WBC≥9.0×10⁹/L、术中输血总量≥1 800 ml、BMI≥24 kg/m²。多因素Logistic回归分析显示，POD1引流液量≥600 ml（OR=4.06，95%CI：1.92~8.59）、POD1-WBC≥9.0×10⁹/L（OR=2.12，95%CI：1.03~4.37）、术中输血总量≥1 800 ml（OR=2.43，95%CI：1.15~5.15）是术后感染的独立危险因素（P<0.05）；BMI≥24 kg/m²呈边缘相关（OR=2.04，95%CI：0.96~4.32，P=0.063），为增强床旁可操作性纳入评分。简易评分模型ROC曲线分析显示，AUC为0.70（95%CI：0.62~0.77），校准度良好（Brier评分=0.211）。趋势性检验显示，感染发生率随评分增加而呈升高趋势（χ²=28.15，P<0.001），其中0分组感染率为8.0%，3~4分组达71.4%。以评分≥1分为初筛截断值，灵敏度为0.97；以评分≥3分为强化干预截断值，特异度为0.94。

该简易评分模型系统取材简便、客观，具有良好的风险分层能力。基于“1分初筛、3分强化”的双阈值分级护理策略，有助于实现肝移植ICU护理资源的精准配置与早期预警。

To construct a simplified scoring model for the risk of early postoperative infection after liver transplantation based on objective nursing indexes within postoperative 24 h, and to evaluate its application value in hierarchical nursing strategies.

Clinical data of 156 recipients who underwent allogeneic liver transplantation at Sun Yat-sen Memorial Hospital from January 2021 to December 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 133 patients were male and 23 female, aged from 18 to 74 years, and a median age of 52 years. Lasso regression was used to screen key characteristic indexes early after liver transplantation. Multivariate Logistic regression was adopted to construct a prediction model for early postoperative infection and convert it into a simple scoring of postoperative infection. Receiver operating characteristic (ROC) curve analysis and Bootstrap internal validation were used to evaluate the efficiency of this prediction model, and stratified nursing strategies were formulated based on the cut-off value.

60 recipients developed infection early after liver transplantation, with an infection rate of 38.5%(60/156). The variables with the top four standardized coefficients screened by Lasso regression included drainage volume on postoperative day 1 (POD1), POD1-WBC, intraoperative blood transfusion and body mass index (BMI). The cut-off value of POD1 drainage volume was ≥600 ml, POD1-WBC≥9.0×10⁹/L, intraoperative blood transfusion≥1 800 ml and BMI≥24 kg/m², respectively. Multivariate Logistic regression analysis showed that POD1 drainage volume≥600 ml (OR=4.06, 95%CI: 1.92-8.59), POD1-WB≥9.0×10⁹/L (OR=2.12, 95%CI: 1.03-4.37), and intraoperative blood transfusion≥1 800 ml (OR=2.43, 95%CI: 1.15-5.15) were the independent risk factors for postoperative infection (all P<0.05). BMI≥24 kg/m² was marginally correlated with postoperative infection (OR=2.04, 95%CI: 0.96-4.32, P=0.063), which was included in the scoring for enhancing bedside operability. ROC curve analysis of the simplified scoring model showed that the area under the ROC curve (AUC) was 0.70 (95%CI: 0.62-0.77) with a high degree of calibration (Brier score=0.211). Trend test showed that the infection rate was increased with the increase of the score (χ²=28.15, P<0.001). The infection rate was 8.0% in the score=0 group and 71.4% in score=3-4 group. When score≥1 was taken as the cut-off value of initial screening, the sensitivity was 0.97. Taking the score≥3 as the cut-off value of intensified interventions, the specificity was 0.94.

The simplified scoring model is simple, objective and has high risk stratification capability. Nursing strategies stratified based on double cut-off value grading of "score=1 for initial screening and score=3 for intensified intervention" contribute to achieving precise allocation and early warning of ICU nursing resources for liver transplantation.