重症成人社区获得性肺炎列线图预测模型的构建和验证  

Construction and verification of a nomogram prediction model of severe adult community-acquired pneumonia

作　　者：王子铭 屈越 黄梅[1] 朱艳婷 彭代保 虞伟[1] Wang Ziming;Qu Yue;Huang Mei;Zhu Yanting;Peng Daibao;Yu Wei(Department of Medical Laboratory,Taikang Xianlin Drum Tower Hospital,Nanjing University School of Medicine,Nanjing 210000,Jiangsu,China;School of Life Sciences,Nanjing Normal University,Nanjing 210023,Jiangsu,China)

机构地区：[1]南京大学医学院附属泰康仙林鼓楼医院检验科,南京210000 [2]南京师范大学生命科学学院,南京210023

出　　处：《中华危重病急救医学》2022年第9期935-940,共6页Chinese Critical Care Medicine

基　　金：江苏省南京市卫生科技发展专项资金项目(YKK20226)。

摘　　要：目的建立并验证基于重症成人社区获得性肺炎(CAP)患者炎症指标、基础疾病、病原学及英国胸科协会改良肺炎评分(CURB-65评分)构建的列线图模型。方法回顾分析2018年1月至2021年12月在泰康仙林鼓楼医院首诊为CAP的172例成人住院患者的临床资料,按病情严重程度分为重症组和非重症组。记录两组患者的基本情况(包括性别、年龄、既往史、合并症和家族史)、临床资料(包括主诉症状、发病时间、CURB-65评分)、入院首次实验室检查(包括血常规、肝肾功能、血生化、凝血功能、微生物培养结果)及是否根据微生物培养结果调整抗菌药物治疗方案。采用单因素分析筛选重症及非重症患者的差异指标,采用多因素Logistic回归分析寻找构建模型的危险因素;基于多因素分析结果构建列线图模型,用受试者工作特征曲线(ROC曲线)及校正曲线评估列线图模型的区分度及校准度。结果共纳入172例成人CAP患者,重症48例,非重症124例;中位年龄74(57,83)岁;发病时间5.0(3.0,10.0)d;合并症总数为3(2,5)种,其中合并高血压58例(33.7%),心力衰竭为17例(9.9%);113例(65.7%)CURB-65评分≤1分,34例(19.8%)CURB-65评分=2分,25例(14.5%)CURB-65评分≥3分。单因素分析显示,重症组与非重症组的年龄、吸烟史、CURB-65评分、心率、发病时间、合并症总数、病原微生物总数、纤维蛋白原(FIB)、D-二聚体、C-反应蛋白(CRP)、降钙素原(PCT)、血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值(NLR)、丙氨酸转氨酶(ALT)及天冬氨酸转氨酶(AST)比较差异均有统计学意义。多因素Logistic回归分析显示,高血压〔优势比(OR)=3.749,95%可信区间(95%CI)为1.411~9.962〕、心力衰竭(OR=4.616,95%CI为1.116~19.093)、复合感染(OR=2.886,95%CI为1.073~7.760)、吸烟史(OR=8.268,95%CI为2.314~29.537)、中高CURB-65评分(OR=4.833,95%CI为1.892~12.346)、CRP(OR=1.012,95%CI为1.002~1.022)、AST(OR=1Objective To construct and verify the nomogram prediction model based on inflammatory indicators,underlying diseases,etiology and the British Thoracic Society modified pneumonia score(CURB-65 score)in adults with severe community acquired pneumonia(CAP).Methods The clinical data of 172 adult inpatients first diagnosed as CAP at Taikang Xianlin Drum Tower Hospital from January 2018 to December 2021 were divided into severe and non-severe diseases groups according to the severity of their conditions.The baseline conditions(including gender,age,past history,comorbidities and family history),clinical data(including chief symptoms,onset time,CURB-65 score),first laboratory results on admission(including whole blood cell count,liver and kidney function,blood biochemistry,coagulation function,microbiological culture results)and whether the antimicrobial therapy was adjusted according to the microbiological culture results were recorded in both groups.Univariate analysis was used to screen for differential indicators between severe and non-severe patients.After covariate analysis,multi-factor Logistic regression analysis was performed based on the Aakaike information criterion(AIC)forward stepwise regression method to rigorously search for risk factors for constructing the model.Based on the results of the multi-factor analysis,a nomogram prediction model was constructed,and the discriminatory degree and calibration degree of the model were assessed using the receiver operator characteristic curve(ROC curve)and calibration curve.Results A total of 172 adult CAP patients were included,48 in severe group and 124 in non-severe group.The median age was 74(57,83)years old,onset time was 5.0(3.0,10.0)days,total number of comorbidities was 3(2,5),including 58 cases(33.7%)with hypertension and 17(9.9%)with heart failure,113(65.7%)with CURB-65 score≤1,34 cases(19.8%)had a CURB-65 score=2 and 25 cases(14.5%)had a CURB-65 score≥3.Univariate analysis showed that there were statistically significant differences between the two gr

关 键 词：成人社区获得性肺炎 炎症指标 CURB-65评分 列线图 

分 类 号：R563.1[医药卫生—呼吸系统] R459.7[医药卫生—内科学]