乳酸联合临床特征建立重症社区获得性肺炎预后列线图预测模型  

Lactic acid combined with clinical features to establish a nomographic prediction model for the prognosis of severe community-acquired pneumonia

作　　者：逯阳 邵东风 姜文 任泓沁 戈艳蕾 Lu Yang;Shao Dongfeng;Jiang Wen;Ren Hongqin;Ge Yanlei(Department of Respiratory, Affiliated Hospital of North China University of Technology, Hebei Province,Tangshan 063000, China)

机构地区：[1]华北理工大学附属医院呼吸科,唐山063000

出　　处：《疑难病杂志》2022年第4期389-393,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：河北省医学科学研究计划项目(20191124,20200136)。

摘　　要：目的以乳酸(LA)联合临床特征相关资料构建重症社区获得性肺炎(SCAP)预后列线图预测模型。方法选取2018年4月—2021年8月华北理工大学附属医院呼吸科收治的SCAP患者235例作为研究对象,按照患者入院30 d内预后情况分为存活组173例和死亡组62例,收集患者临床资料及实验室检查指标,多因素Logistic回归分析影响SCAP患者预后的因素,以此为基础构建列线图预测模型,再绘制H-L拟合度曲线评估模型的有效性,应用受试者工作特征曲线(ROC)评估列线图模型的区分度。结果死亡组年龄、合并冠心病比例、合并糖尿病比例、脓毒性休克发生率、LA、C反应蛋白(CRP)、肺炎严重指数(PSI)评分危险分级4~5级比例均高于存活组(χ^(2)/t/P=5.456/<0.001、7.104/0.008、4.134/0.042、10.638/0.001、6.686/<0.001、12.521/<0.001、21.740/<0.001);高龄、高水平LA、PSI评分危险分级4~5级是影响SCAP患者预后的独立危险因素[OR(95%CI)=1.841(1.780~1.907)、1.345(1.222~1.537)、1.188(1.086~1.411)];H-L拟合度曲线提示列线图预测模型具有较好的预测有效性(χ^(2)=6.754,P=0.314);ROC分析显示,列线图预测模型曲线下面积为0.828,敏感度为0.780,特异度为0.774,提示该模型具有较好的区分度。结论以LA水平联合年龄、PSI评分危险分级构建SCAP预后的列线图预测模型,具有较高的有效性及区分度,可作为临床预测SCAP患者预后的有效工具。Objective To construct a nomogram prediction model for the prognosis of severe community-acquired pneumonia(SCAP)based on lactate(LA)combined with clinical characteristics-related data.Methods A total of 235 SCAP patients admitted to the Department of Respiratory Medicine,North China University of Science and Technology Affiliated Hospital from April 2018 to August 2021 were selected as the research subjects.According to the prognosis within 30 days of admission,the patients were divided into a survival group of 173 cases and a death group of 62 cases.The clinical data and laboratory test indicators of the patients were collected,and the factors affecting the prognosis of SCAP patients were analyzed by multivariate Logistic regression.Based on this,a nomogram prediction model was constructed,and then the H-L fitting curve was drawn to evaluate the validity of the model.The characteristic curve(ROC)evaluates the discriminativeness of the nomogram model.Results The age,the proportion of coronary heart disease,the proportion of diabetes,the incidence of septic shock,LA,C-reactive protein(CRP),and pneumonia severity index(PSI)in the death group were higher than those in the survival group(χ^(2)/t/P=5.456/<0.001,7.104/0.008,4.134/0.042,10.638/0.001,6.686/<0.001,12.521/<0.001,21.740/<0.001).Older age,high level of LA,and PSI score risk grade 4-5 were independent risk factors affecting the prognosis of SCAP patients[OR(95%CI)=1.841(1.780-1.907),1.345(1.222-1.537),1.188(1.086)-1.411].The H-L fitting curve indicated that the nomogram prediction model had good predictive validity(χ^(2)=6.754,P=0.314).ROC analysis showed that the area under the curve of the nomogram prediction model was 0.828,the sensitivity was 0.780,and the specificity was 0.774,indicating that the model has a good degree of discrimination.Conclusion The nomogram prediction model of SCAP prognosis was constructed based on LA level combined with age and PSI score risk classification.

关 键 词：重症社区获得性肺炎 乳酸 年龄 肺炎严重指数评分 列线图 预测模型 

分 类 号：R563.1[医药卫生—呼吸系统]