研究背景：脑卒中（stroke）是一种急性起病的脑血管疾病。在我国，脑卒中的患病率与发病率不断上升，且致残率高、致死率高，疾病负担大。脑卒中患者受到脑神经损伤的影响，神经、肌肉、骨关节等多个器官和系统的功能发生障碍，使得卧床状态在患者中非常常见。因此，患者发生卧床并发症的风险极大。泌尿系统感染（urinary tract infections, UTIs）是脑卒中卧床患者最常见的并发症之一，不仅会延长住院时间、加剧痛苦，而且是发生不良预后的独立预测因子。因此，评估识别泌尿系统感染的高危人群就成为脑卒中卧床患者并发症管理的重要任务。然而现有的研究大多关注风险因素的探索，针对泌尿系统感染评估工具的开发较少。有必要设计一款适合脑卒中卧床患者的泌尿系统感染风险评估工具，协助护士早期筛查高危患者，提高临床护理质量、改善并发症的预防管理工作。

研究目的：探讨脑卒中卧床患者泌尿系统感染的风险因素；开发脑卒中卧床患者泌尿系统感染风险评分工具并进行初步验证。

研究方法：采用前瞻性多中心研究《卧床患者常见并发症规范化护理干预模式的构建》中收集的脑卒中卧床患者作为研究样本，按照70% vs. 30%的数量随机分成建模组、验证组，前者用于构建风险模型及评分工具，后者用于评分工具的内部验证。通过收集患者的人口社会学资料、住院状态资料、医疗护理行为相关资料、疾病相关资料，对泌尿系统感染可能的风险因素进行单因素分析，筛选整理后对建模组样本采用二元logistic回归模型分析。利用多因素分析获得的OR（Odds Ratio）值构建脑卒中卧床患者泌尿系统感染风险评分工具。最后使用风险评分工具对验证组样本进行验证。

研究结果：本研究共纳入3982例脑卒中卧床患者，入组后新发泌尿系统感染共103例，发病率为2.59%。建模组（2795例）多因素分析显示：性别（女性）、留置尿管天数、脑卒中类型（混合性）、合并肺部感染、使用糖皮质激素是脑卒中卧床患者发生泌尿系统感染的风险因素，气管切开操作是保护性风险因素。根据风险因素构建的风险评分工具得分范围为：-3分~14分，AUC（Area Under Curve）=0.802，Youden指数取最大值（0.506）时, 可得临界值（cut off）=3.5分，以4分为界，将评分工具划分为低危组（-3分~0分），中危组（1分~4分），高危组（≥5分）三层。根据新的分层标准，在建模组中三类风险人群泌尿系统感染的发病率分别为0.2%、1.7%、6.4%，不同类别风险人群发病率差异存在统计学意义（P<0.001）。经验证组（1187例）检验，对脑卒中卧床患者进行赋值并分层，结果显示：低危组，中危组，高危组的泌尿系统感染发病率分别为0.6%、1.9%、8.9%，差异具有统计学意义（P<0.001）。

研究结论：本研究发现性别（女性）、留置尿管天数、脑卒中类型（混合性）、合并肺部感染、使用糖皮质激素是脑卒中卧床患者泌尿系统感染的风险因素，气管切开操作是保护性风险因素。基于上述风险因素构建的脑卒中卧床患者泌尿系统感染风险评分工具总分范围：-3分~14分，能够根据发生泌尿系统感染的风险将脑卒中卧床患者分为低危组（-3分~0分），中危组（1分~4分），高危组（≥5分）三层，经过初步验证，具有可行性与实用性。

Background: Stroke is an acute cerebrovascular disease. In China, the prevalence and morbidity of stroke are increasing, with the characteristics of high disability and high mortality, and a large disease burden. Stroke patients are affected by cerebral nerve damage, which makes bedridden, hemiplegia and other states very common in the clinic, increasing the possibility of bedridden complications. Urinary tract infections (UTIs) are one of the most common complications of stroke patients. Complicating UTIs during hospitalization not only prolongs the hospital stay and aggravates the patient's suffering, but also is an independent predictor of poor prognosis of stroke patients. Therefore, assessing and identifying high-risk groups of UTIs has become an important task for the management of complications of immobile inpatients with stroke. However, most of the existing research focused on the exploration of risk factors. There were few studies related to the development of risk tools for UTIs. A unified risk score has not yet been formed internationally. Therefore, it is necessary to design a suitable risk score of UTIs for immobile inpatients with stroke, to assist nurses to screen high-risk patients early, improve the quality of clinical care, and improve the prevention and management of complications.

Objective: To explore the risk factors of UTIs in immobile inpatients with stroke; to develop and verify the risk score for UTIs in immobile inpatients with stroke.

Method: The prospective multicenter study " The Common Complications of Bedridden Inpatients and the Construction of Standardized Nursing Intervention Model " was used as the study sample, and the inpatients were randomly divided into modeling group and verification group according to the number of 70% vs. 30%, the former was used to build risk models and risk score, and the latter was used for internal verification of risk score. Analyzing the patient's demographic data, hospitalization data, medical care related data, and disease related data. In univariate analysis, the possible influencing factors of UTIs was screened and sorted, then a binary logistic regression model was used to determine the risk factors. The risk factor OR (Odds Ratio) value obtained by multivariate analysis was used to construct a risk score for UTIs in immobile inpatients with stroke. Finally, we used the risk scoring to verify and analyze the samples of the verification group.

Results: A total of 3982 immobile inpatients with stroke were enrolled in this study. After enrollment, a total of 103 new UTIs occurred, with an incidence rate of 2.59%. Multivariate analysis of the modeling group (2795 cases) showed that: gender (female), days of indwelling urinary catheter, stroke type, combined pneumonia, and glucocorticoid use were independent risks factor of UTIs in immobile inpatients with stroke, tracheotomy is a protective factor. The risk score was constructed according to risk factors has a score range from -3 to 14 points, AUC (Area Under Curve) = 0.802, and when the Youden index is at its maximum (0.506), the cut off value = 3.5 points, so 4 point divided into boundaries, the scoring score was divided into three layers: low-risk group (-3 points to 0 points), medium-risk group (1 point to 4 points), and high-risk group (≥5 points). According to the new stratification standard, the incidence of UTIs in the three risk groups in the modeling group was 0.2%, 1.7%, and 6.4%, respectively, and there was a statistically significant difference in the incidence of different risk groups (P <0.001). The verification group (1187 cases) tested and assigned risk scores and stratified immobile inpatients with stroke. The results showed that the incidence of UTIs in the low-risk group, the medium-risk group, and the high-risk group were 0.6%, 1.9%, and 8.9%, respectively. The difference was statistically significant (P <0.001).

Conclusions: This study confirmed the risk factors of UTIs in immobile inpatients with stroke: gender (female), tracheotomy, days of indwelling urinary catheter, stroke type, combined pneumonia, use of glucocorticoids, of which the tracheotomy is a protective factor. Based on the above risk factors, the total score range of the urinary tract infection risk score for immobile inpatients with stroke is: -3 points to 14 points. According to the risk of UTIs, immobile inpatients with stroke can be divided into low-risk groups (-3 points ~ 0 points), middle-risk group (1 point to 4 points), high-risk group (≥ 5 points), after preliminary verification, it is feasible and practical.