摘要
目的探讨社区获得性肺炎(CAP)成人患者并发急性呼吸衰竭(ARF)的危险因素,并构建和验证列线图模型的效能。方法回顾性收集2018年1月至2021年12月南京大学医学院附属泰康仙林鼓楼医院就诊并住院的172例成人CAP患者的临床及实验室资料,按是否并发ARF分为两组,单因素比较两组差异指标后经共线性分析,依据向前逐步回归法进行二元logistic回归分析筛选危险因素,构建列线图模型,ROC曲线及校正曲线评估模型的区分度及校准度。结果172例CAP成人CAP患者中并发ARF 53例(30.8%)。单因素分析结果显示,并发ARF组患者较未并发组,年龄、CURB-65评分、炎症指标更高,复合感染(培养出2种及以上病原菌)发生率高,C反应蛋白(CRP)、血尿素氮/白蛋白(BUN/Alb)等指标差异均有统计学意义[53.910(25.900,101.200)vs.23.300(6.800,48.930)、0.231(0.160,0.302)vs 0.123(0.089,0.171),P<0.05]。多因素分析示:血糖(Glu)≥6.06 mmol/L[优势比(OR)为2.737,95%可信区间(CI)为1.116~7.037];天门冬氨酸氨基转移酶(AST)≥22.5 U/L(OR为4.291,95%CI为1.779~11.120);纤维蛋白原(Fib)≤3.83 g/L(OR为3.955,95%CI为1.631~10.237);尿酸(UA)≤188.07μmol/L(OR为4.617,95%CI为1.859~12.489);BUN/Alb≥0.15 mmol/g(OR为6.381,95%CI为2.423~18.513);共病总数≥3种(OR为6.191,95%CI为2.088~21.905)为独立危险因素(P<0.05)。将筛选指标纳入列线图模型并验证模型效能,结果示:列线图模型曲线下面积为0.888(95%CI:0.840~0.935)(P<0.05),敏感性为0.868,特异性为0.790;校准曲线显示成人CAP并发ARF的预测概率与观察概率一致性较好(Briser Score为0.125;H-L检验:χ^(2)=7.563,P=0.477)。结论构建的模型具有良好的预测成人CAP并发ARF的能力,可为临床早期预测及干预治疗提供参考依据。
Objective To explore the risk factors of acute respiratory failure(ARF)in adult patients with community-acquired pneu-monia(CAP),and thereby construct and validate the efficacy of nomogram model.Methods The clinical and laboratory data of 172 adult CAP patients admitted to Taikang Xianlin Drum Tower Hospital affiliated to Nanjing University School of Medicine from January 2018 to December 2021 were retrospectively collected.The patients were divided into two groups based on whether they had concurrent ARF.After the comparison for the differences of single factor between the two groups,collinearity analysis was assessed.The risk fac-tors were then screened by binary logistic regression analysis with forward stepwise regression method.A nomogram model was subse-quently constructed and the discrimination and accuracy of the model were evaluated by ROC and colibration curves.Results Among the 172 CAP patients,53 cases(30.8%)developed ARF.The results of univariate analysis showed that the CAP patients with concur-rent ARF group had higher age,CURB-65 score and inflammatory markers than the non-concurrent ARF group,and the incidence of complex infection(culturing two or more pathogenic bacteria)was high.The values of CRP(C-reactive protein)and BUN/Alb(blood urea nitrogen/albumin)were significantly different between the two groups(53.910[25.900,101.200]vs.23.300[6.800,48.930],0.231[0.160,0.302]vs.0.123[0.089,0.171],P<0.05).Multivariate analysis indicated:glucose(Glu)≥6.06 mmol/L(odds ra-tio(OR):2.737,95%confidence interval(CI):1.116-7.037),AST(aspartate aminotransferase)≥22.5 U/L(OR:4.291,95%CI:1.779-11.120),fibrinogen(Fib)≤3.83 g/L(OR:3.955,95%CI:1.631-10.237),uric acid(UA)≤188.07μmol/L(OR:4.617,95%CI:1.859-12.489),BUN/Alb≥0.15 mmol/g(OR:6.381,95%CI:2.423-18.513),total number of multicomor-bidity≥3(OR:6.191,95%CI:2.088-21.905)were the risk factors(P<0.05).All the screened indicators were incorporate into the nomogram model and its efficacy was verified.The results showed that the area under the curve of the model was 0.888[95%CI:0.840-0.935](P<0.05),the sensitivity was 0.868,and the specificity was 0.790.The calibration curve showed that the predicted probability of adult CAP patients-associated with ARF was in good consistency with the observed probability(Briser Score:0.125;H-L test:χ^(2)=7.563,P=0.477).Conclusion The established model has a good ability to predict adult CAP associated with ARF,and can provide a reference basis for early clinical prediction and intervention treatment.
作者
王子铭
屈越
李丹丹
周慧聪
吴彬彬
虞伟
WANG Ziming;QU Yue;LI Dandan;ZHOU Huicong;WU Binbin;YU Wei(Department of Medical Laboratory,Taikang Xian-lin Drum Tower Hospital,Nanjing University School of Medicine,Nanjing 210046;School of Life Sciences,Nanjing Normal Universi-ty,Nanjing 210023,Jiangsu,China)
出处
《临床检验杂志》
2025年第8期586-590,共5页
Chinese Journal of Clinical Laboratory Science
基金
南京大学医学院附属泰康仙林鼓楼医院基金项目(TKKYLC20221602)
南京市卫生科技发展专项资金项目(YKK20226)。
关键词
社区获得性肺炎
急性呼吸衰竭
预测模型
community acquired pneumonia
acute respiratory failure
prediction model
