老年慢性阻塞性肺疾病急性加重病人呼吸机相关性肺炎诺莫图模型的预测价值  

Predictive value of the nomogram model for ventilator-associated pneumonia in elderly patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：吕培瑾[1] 李书阅[1] 蒋云书 董亮亮[1] LYU Peijin;LI Shuyue;JIANG Yunshu;DONG Liangliang(Department of Respiratory Medicine,Liaocheng Second People's Hospital,Liaocheng,Shandong252600,China)

机构地区：[1]聊城市第二人民医院呼吸内科,山东聊城252600

出　　处：《安徽医药》2024年第1期164-167,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的筛选老年慢性阻塞性肺疾病(COPD)急性加重病人发生呼吸机相关性肺炎(VAP)的危险因子,验证以此构建的诺莫图预测模型的价值。方法以2016年12月至2021年11月聊城市第二人民医院收治的374例老年COPD病人为研究对象,按6∶4的比例,采用随机数字表法分为建模集(n=225)与验证集(n=149)。分析VAP的影响因素,建立诺莫图模型并评估其预测价值。结果VAP组病人年龄[(70.56±6.33)岁比(68.01±6.06)岁]、急性生理和慢性健康(APACHEⅡ)评分[(20.44±6.89)分比(12.20±4.60)分]、序贯器官衰竭(SOFA)评分[(7.65±3.32)分比4.12±1.82)分]、有吸烟史比例(71.9%比54.8%)、合并基础疾病≥3种比例(45.6%比18.5%)、过去90 d使用抗生素比例(63.2%比40.5%)、呼吸机通气时长≥4 d比例(77.2%比40.5%)、再次插管比例(80.7%比46.4%)较非VAP组升高(P<0.05)。logistic回归分析结果示,合并基础疾病≥3种(OR=2.78,P=0.027)、APACHEⅡ评分(OR=9.46,P<0.001)、SOFA评分(OR=2.99,P=0.010)、过去90 d使用抗生素(OR=2.71,P=0.015)、呼吸机通气时长≥4 d(OR=3.24,P=0.006)、再次插管(OR=3.65,P=0.004)是发生VAP的独立危险因素。建模集及验证集校准曲线结果均显示,构建的诺莫图预测模型校准度较好,ROC曲线下面积分别为0.87[95%CI:(0.82,0.93)]、0.83[95%CI:(0.75,0.92)]。结论通过合并基础疾病≥3种、APACHEⅡ评分、SOFA评分、过去90 d使用抗生素、呼吸机通气时长≥4 d、再次插管等危险因素建立的诺莫图模型对老年COPD急性加重病人发生VAP具有较好的预测价值。Objective To screen the risk factors for ventilator-associated pneumonia(VAP)in elderly patients with acute exacerba⁃tion of chronic obstructive pulmonary disease(COPD),and to verify the value of the nomogram prediction model constructed in this way.Methods A total of 374 elderly COPD patients who were admitted to the Liaocheng Second People's Hospital from December 2016 to November 2021 were included in the study,and the subjects were divided into a modeling set(n=225)and a validation set(n=149)at a ratio of 6:4 and by using the random number table method.The influencing factors of VAP were analyzed,a nomogram model was estab⁃lished and its predictive value was evaluated.Results The age of patients in the VAP group[(70.56±6.33)years vs.(68.01±6.06)years],Acute Physiology and Chronic Health(APACHEⅡ)score[(20.44±6.89)points vs.(12.20±4.60)points],Sequential Organ Fail⁃ure(SOFA)score[(7.65±3.32)points vs.(4.12±1.82)points],proportion with history of smoking(71.9%vs.54.8%),proportion with≥3 comorbid underlying diseases(45.6%vs.18.5%),proportion with antibiotics in the past 90 d(63.2%vs.40.5%),proportion with≥4 d of ventilatory ventilation(77.2%vs.40.5%),and proportion with reintubation(80.7%vs.46.4%)were elevated compared with those in the non-VAP group(P<0.05).Logistic regression analysis showed that combined underlying diseases≥3(OR=2.78,P=0.027),APACHEⅡscore(OR=9.46,P<0.001),SOFA score(OR=2.98,P=0.010),use of antibiotics in the past 90 days(OR=2.71,P=0.015),ventilator ventilation duration≥4 days(OR=3.23,P=0.006),and reintubation(OR=3.65,P=0.004)were independent risk factors for VAP.The calibration curve results of both the modeling set and the validation set showed that the constructed nomogram prediction model had good calibration,and the areas under the ROC curve were 0.87[95%CI:(0.82,0.93)]and 0.83[95%CI:(0.75,0.92)],respec⁃tively.Conclusion The nomogram model established by risk factors including combined underlying diseases≥3,APACHEⅡscore,SOFA score,antibiotic use in the past 90

关 键 词：肺疾病 慢性阻塞性 肺炎 呼吸机相关性 抗菌药 危险因素 诺莫图 

分 类 号：R563.9[医药卫生—呼吸系统] R563.1[医药卫生—内科学]