切换至 "中华医学电子期刊资源库"

中华危重症医学杂志(电子版) ›› 2025, Vol. 18 ›› Issue (01) : 31 -37. doi: 10.3877/cma.j.issn.1674-6880.2025.01.006

荟萃分析

ICU 患者失禁相关性皮炎风险预测模型的系统评价
张洋1, 刘志燕1,(), 王先美1, 孙燕1, 曾钰1   
  1. 1. 550025 贵阳,贵州医科大学护理学院
  • 收稿日期:2024-07-03 出版日期:2025-02-28
  • 通信作者: 刘志燕
  • 基金资助:
    贵州医科大学护理学科专项科学项目(YJ22020)

Prediction models for risk of incontinence-associated dermatitis in ICU patients: a systematic review

Yang Zhang1, Zhiyan Liu1,(), Xianmei Wang1, Yan Sun1, Yu Zeng1   

  1. 1. School of Nursing,Guizhou Medical University,Guiyang 550025,China
  • Received:2024-07-03 Published:2025-02-28
  • Corresponding author: Zhiyan Liu
引用本文:

张洋, 刘志燕, 王先美, 孙燕, 曾钰. ICU 患者失禁相关性皮炎风险预测模型的系统评价[J/OL]. 中华危重症医学杂志(电子版), 2025, 18(01): 31-37.

Yang Zhang, Zhiyan Liu, Xianmei Wang, Yan Sun, Yu Zeng. Prediction models for risk of incontinence-associated dermatitis in ICU patients: a systematic review[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2025, 18(01): 31-37.

目的

系统评价ICU 患者失禁相关性皮炎(IAD)风险预测模型。

方法

计算机检索中国知网、万方、维普、CBM、PubMed、Embase、Web of Science 和the Cochrane Library 数据库有关ICU 患者IAD 风险预测模型的研究,检索时限为建库至2023 年7 月23 日。由2 名研究者独立筛选文献、提取数据,并对纳入文献的偏倚风险和适用性进行评价。使用Revman5.4 软件对模型中预测因子的预测价值进行Meta 分析。

结果

共纳入8 项研究,其中有6 项研究为模型开发,2 项研究为会阴部位皮肤状况评估工具(PAT)评分表的外部验证研究。有6 项研究使用logistic 回归分析建模,2 项研究使用外部验证,3 项研究使用内部验证。模型的受试者工作特征曲线下面积(AUC)为0.795 ~0.974。Meta 分析结果显示,血清白蛋白(ALB)[比值比(OR)=2.45,95%置信区间(CI)(1.68,3.59),Z = 4.62,P <0.001]、发烧(体温≥38 ℃)[OR = 2.29,95%CI(1.39,3.79),Z=3.23,P=0.001]、稀便[OR = 6.93,95%CI(4.50,10.65),Z = 8.81,P <0.001]及PAT评分[OR=2.56,95%CI(1.23,5.30),Z=2.53,P=0.01]是ICU 患者IAD 发生风险的影响因素。

结论

ICU 患者IAD 风险预测模型尚有不足,模型在开发设计、统计分析及报道等方面有一定的偏倚,期待未来通过多中心、大样本量的研究进行模型验证与更新,以提高模型性能。

Objective

To systematically review the risk prediction models for incontinenceassociated dermatitis (IAD) in ICU patients.

Methods

The databases of CNKI,Wanfang,VIP,CBM,PubMed,Embase,Web of Science and the Cochrane Library were searched for the literature on risk prediction models for IAD in ICU patients published up to July 23,2023.Two researchers independently screened the literature,extracted relevant data,and evaluated the risk of bias and applicability of involved literature.Meta-analysis of the predictive value of predictors in the model was performed using Revman5.4.

Results

A total of eight studies were involved,including six model development studies and two external validation studies for the perineal assessment tool (PAT).Six studies used logistic regression models,two used external validation,and three used internal validation.The area under the receiver operating characteristic curve of the involved models ranged from 0.795 to 0.974.Meta-analysis showed that serum albumin [odds ratio (OR) = 2.45,95% confidence interval (CI) (1.68,3.59),Z = 4.62,P <0.001],fever (body temperature ≥38 ℃) [OR=2.29,95%CI (1.39,3.79),Z=3.23,P=0.001],loose stools [OR=6.93,95%CI (4.50,10.65),Z=8.81,P <0.001] and PAT [OR=2.56,95%CI (1.23,5.30),Z = 2.53,P = 0.01] were influential factors for the risk of IAD in ICU patients.

Conclusions

The existing predictive models for IAD in ICU patients are not ideal,as they exhibit bias in the development,design,statistical analysis and reporting.In the future,model validation and updates should be conducted to improve their performance through large-scale and multi-center studies.

表1 纳入文献的基本特征
表2 ICU 患者IAD 发生风险预测模型的建立情况
表3 ICU 患者IAD 发生风险预测模型的模型报告
表4 纳入ICU 患者IAD 发生风险预测模型研究偏倚风险的评估结果
表5 纳入8 个风险预测模型中相同预测因子的Meta 分析
1
Gray M,Beeckman D,Bliss DZ,et al.Incontinenceassociated dermatitis: a comprehensive review and update [J].J Wound Ostomy Continence Nurs,2012,39 (1): 61-74.
2
Sharma P,Latha S,Sharma RK.Development of a need-based interventional skin care protocol on incontinence-associated dermatitis among critically ill patients [J].Indian J Crit Care Med,2021,25 (2):158-165.
3
Gates BP,Vess J,Long MA,et al.Decreasing incontinence-associated dermatitis in the surgical intensive care unit: a quality improvement project [J].J Wound Ostomy Continence Nurs,2019,46 (4): 327-331.
4
Jiang H,Shen J,Lin H,et al.Risk factors of incontinence-associated dermatitis among critically ill patients: a systematic review and meta-analysis [J].Front Med (Lausanne),2023 (10): 1146697.
5
Wang X,Zhang Y,Zhang X,et al.Incidence and risk factors of incontinence-associated dermatitis among patients in the intensive care unit [J].J Clin Nurs,2018,27 (21-22): 4150-4157.
6
Zhang Y,Zhang P,Liu JE,et al.A qualitative study on the experience and training needs of ICU nurses for incontinence-associated dermatitis [J].Adv Skin Wound Care,2021,34 (10): 532-537.
7
Zhang Y,Leng M,Guo J,et al.The effectiveness of faecal collection devices in preventing incontinenceassociated dermatitis in critically ill patients with faecal incontinence: a systematic review and meta-analysis[J].Aust Crit Care,2021,34 (1): 103-112.
8
Yüceler Kacmaz H,Kaplan O,Kaplan A,et al.Incontinence-associated dermatitis: prevalence in intensive care units and knowledge,attitudes,and practices of nurses[J].J Nurs Care Qual,2023,38 (4): 354-360.
9
Moons KG,de Groot JA,Bouwmeester W,et al.Critical appraisal and data extraction for systematic reviews of prediction modelling studies: the CHARMS checklist[J].PLoS Med,2014,11 (10): e1001744.
10
Wolff RF,Moons KGM,Riley RD,et al.PROBAST: a tool to assess the risk of bias and applicability of prediction model studies [J].Ann Intern Med,2019,170 (1): 51-58.
11
李晓艳,刘革婷,吴静,等.会阴评估工具对ICU 失禁患者失禁性皮炎发生的预警作用及相关危险因素分析[J].护理管理杂志,2017,17(4):232-234.
12
史广玲,徐建珍,刘夕珍,等.重症监护病房患者大便失禁相关性皮炎预测风险模型的建立和验证[J].解放军护理杂志,2021,38(11):37-40,45.
13
钟丽霞,王欣然.外科ICU 患者失禁相关性皮炎发生的危险因素及预测模型研究[J].中国医药导报,2020,17(5):109-112.
14
巨婷,何海燕,傅静,等.ICU 失禁患者失禁相关性皮炎风险预测模型[J].中国老年学杂志,2022,42(3):618-622.
15
周静.ICU 患者失禁相关性皮炎风险评估工具的构建及评价[D].沈阳:中国医科大学,2021.
16
Wei L,Bao Y,Chai Q,et al.Determining risk factors to develop a predictive model of incontinence-associated dermatitis among critically ill patients with fecal incontinence: a prospective,quantitative study [J].Wound Manag Prev,2019,65 (4): 24-33.
17
Li YM,Lee HH,Lo YL,et al.Perineal assessment tool (PAT-C): validation of a Chinese language version and identification of a clinically validated cut point using ROC curve analysis [J].J Wound Ostomy Continence Nurs,2019,46 (2): 150-153.
18
Van Damme N,Clays E,Verhaeghe S,et al.Independent risk factors for the development of incontinence-associated dermatitis(category 2) in critically ill patients with fecal incontinence: a crosssectional observational study in 48 ICU units [J].Int J Nurs Stud,2018 (81): 30-39.
19
刘雨安,杨小文,李乐之.机器学习在疾病预测的应用研究进展[J].护理学报,2021,28(7):30-34.
20
Abbasgholizadeh Rahimi S,Légaré F,Sharma G,et al.Application of artificial intelligence in community-based primary health care: systematic scoping review and critical appraisal[J].J Med Internet Res,2021,23 (9):e29839.
21
Chu H,Moon S,Park J,et al.The use of artificial intelligence in complementary and alternative medicine:a systematic scoping review [J].Front Pharmacol,2022(13): 826044.
22
Collins GS,Reitsma JB,Altman DG,et al.Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis(TRIPOD): the TRIPOD statement[J].BMJ,2015 (350): g7594.
23
何海燕.失禁相关性皮炎风险预测模型的初步建立及验证[D].泸州:西南医科大学,2018.
24
Dabrowska AK,Spano F,Derler S,et al.The relationship between skin function,barrier properties,and body-dependent factors[J].Skin Res Technol,2018,24(2): 165-174.
25
张宇,张晓雪,赵晓维,等.危重症患者失禁性皮炎的发生现况及其影响因素 [J].解放军护理杂志,2018,35(16):16-21,26.
26
Coyer F,Campbell J,Doubrovsky A.Efficacy of incontinence-associateddermatitisinterventionfor patients in intensive care: an open-label pilot randomized controlled trial [J].Adv Skin Wound Care,2020,33 (7): 375-382.
27
刘丽,程丽娟,王招娣,等.危重症患者肠内营养的研究进展[J/OL].中华危重症医学杂志(电子版),2023,16(2):167-171.
28
徐晶晶,贾静,仇晓溪.失禁病人发生失禁性皮炎的危险因素分析[J].护理研究,2016,30(5):597-599.
29
徐少毅,冯雪君,蔡继明,等.ICU 腹泻患者艰难梭菌感染分子流行病学特征和危险因素[J/OL].中华危重症医学杂志(电子版),2018,11(5):330-334.
30
蔺伟,贾晓鹏,唐学飞,等.ICU 重症患者艰难梭菌感染情况及危险因素 [J].中华医院感染学杂志,2021,31(16):2436-2441.
31
Demarre L,Verhaeghe S,Van Hecke A,et al.Factors predicting the development of pressure ulcers in an atrisk population who receive standardized preventive care: secondary analyses of a multicentre randomised controlled trial[J].J Adv Nurs,2015,71 (2): 391-403.
32
范思越,陈丽娟,江鸿展,等.危重症患者失禁相关性皮炎风险预测工具的研究进展[J].中华护理杂志,2023,58(22):2812-2817.
33
Campbell J,Cook JL,Doubrovsky A,et al.Exploring incontinence-associated dermatitis in a single center intensive care unit: a longitudinal point prevalence survey[J].J Wound Ostomy Continence Nurs,2019,46(5): 401-407.
[1] 王昕玥, 袁亚, 束华, 曹琨芃, 叶新华, 李璐. 基于LightGBM 算法构建超声引导下凝血酶治疗假性动脉瘤剂量预测模型[J/OL]. 中华医学超声杂志(电子版), 2025, 22(02): 153-161.
[2] 洪玮, 叶细容, 刘枝红, 杨银凤, 吕志红. 超声影像组学联合临床病理特征预测乳腺癌新辅助化疗完全病理缓解的价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 571-579.
[3] 丁文珠, 汪谦. 直肠癌经肛全直肠系膜切除术的肿瘤学结局:一项系统评价和Meta 分析[J/OL]. 中华普通外科学文献(电子版), 2025, 19(01): 66-72.
[4] 袁强, 张华宇, 闫璋哲, 朱含放, 陈光, 孙亮, 吕远, 陈纲, 赵锁. cN0峡部偏侧甲状腺乳头状癌中央区淋巴结转移的术前预测模型[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(03): 333-336.
[5] 朱宗恒, 张志火. 甲状腺乳头状癌对侧中央区淋巴结转移的危险因素分析及预测模型构建[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(03): 337-340.
[6] 奚玲, 仝瀚文, 缪骥, 毛永欢, 沈晓菲, 杜峻峰, 刘晔. 基于肌少症构建的造口旁疝危险因素预测模型[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 48-51.
[7] 屈勤芳, 束方莲. 盆腔器官脱垂患者盆底重建手术后压力性尿失禁发生的影响因素及列线图预测模型构建[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 606-612.
[8] 李鑫, 李乐, 陈金明, 刘蕊. 基于Meta 分析构建肝癌微血管侵犯的术前预测模型[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 74-80.
[9] 王贝贝, 崔振义, 王静, 王晗妍, 吕红芝, 李秀婷. 老年股骨粗隆间骨折患者术后贫血预测模型的构建与验证[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 355-362.
[10] 张泽延, 段止璇, 吴惠群, 王国栋, 凌华, 杜晓霞. 亚急性期脑卒中患者心肺适能预测模型的构建及验证[J/OL]. 中华脑科疾病与康复杂志(电子版), 2025, 15(01): 15-20.
[11] 任船, 葛荣忠, 邱正才, 朱莉. 肠癌患者术后代谢性酸中毒的预测模型构建及应用价值评价[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(01): 34-39.
[12] 韦巧玲, 黄妍, 赵昌, 宋庆峰, 陈祖毅, 黄莹, 蒙嫦, 黄靖. 肝癌微波消融术后中重度疼痛风险预测列线图模型构建及验证[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 715-721.
[13] 蔡晓雯, 李慧景, 丘婕, 杨翼帆, 吴素贤, 林玉彤, 何秋娜. 肝癌患者肝动脉化疗栓塞术后疼痛风险预测模型的构建及验证[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 722-728.
[14] 洪凡, 王志坚. 瘢痕子宫再妊娠并发症预测模型的研究进展[J/OL]. 中华产科急救电子杂志, 2025, 14(01): 20-25.
[15] 马钰杰, 游雨禾, 朴哲, 薛洪省, 曹文军, 王珍, 赵志龙. 人工智能在肺结节预测模型中应用的研究现状[J/OL]. 中华胸部外科电子杂志, 2025, 12(01): 39-48.
阅读次数
全文


摘要