老年患者肺部感染耐碳青霉烯肠杆菌预后模型的建立和验证  

Establishment and validation of prognostic model of carbapenem-resistant Enterobacter in elderly patients with pulmonary infection

作　　者：王莎莎 王书 张颖 赵诗琦 唐文娟[3] 李静[4] 张学敏 WANG Shasha;WANG Shu;ZHANG Ying;ZHAO Shiqi;TANG Wenjuan;LI Jing;ZHANG Xuemin(Department of Geriatrics,Hefei Binhu Hospital,Anhui Medical University Third Affiliated Hospital,Hefei 230061,China;不详)

机构地区：[1]安徽医科大学第三附属医院合肥市滨湖医院老年医学科,合肥230061 [2]安徽医科大学第三附属医院合肥市第一人民医院老年医学科 [3]安庆市立医院老年医学科 [4]中国科学技术大学第一附属医院(安徽省立医院)老年医学科 [5]安徽医科大学附属阜阳医院呼吸内科

出　　处：《中国临床保健杂志》2024年第2期210-217,共8页Chinese Journal of Clinical Healthcare

基　　金：安徽省高等学校科学研究项目(自然科学类)重点项目(2022AH052334);合肥市卫生健康委2022年度应用医学重点研究项目(Hwk2022zd003)。

摘　　要：目的分析老年患者肺部感染耐碳青霉烯类肠杆菌(CRE)预后不良的危险因素并构建预测模型。方法回顾性分析安徽省5家医院404例肺部感染痰培养阳性的老年住院患者(≥60岁)的临床资料,原始数据中按照约7∶3的比例选择3家医院,纳入其患者作为训练集共294例样本,其余2家医院作为验证集共110例样本。分别采用LASSO回归及COX多因素回归模型分析老年患者CRE肺部感染预后不良的独立危险因素,根据独立危险因素对训练集患者进行风险评分并将其分为低危组与高危组,应用R(4.2.1)软件依据独立危险因素及风险分组建立预后预测模型并对其进行验证。结果气管插管、胃管置入、营养不良、慢性阻塞性肺疾病、休克为老年患者CRE肺部感染预后不良的独立危险因素(P均<0.05)。通过该5项危险因素及风险分组构建预测模型并进行验证,验证结果显示:训练集和验证集受试者工作特征曲线下面积分别为0.821、0.806,提示该模型诊断能力良好;校准曲线分析提示该模型拟合良好;决策曲线分析显示该模型获益性尚可。结论通过列线图模型可个体化预测CRE肺部感染的老年患者发生不良预后的概率。Objective To analyze the risk factors of poor prognosis of carbapenem-resistant Enterobacter in elderly patients with pulmonary infection and to establish a predictive model.Methods The clinical data of 404 elderly inpatients(≥60 years old)with positive sputum culture of pulmonary infection in 5 hospitals in Anhui Province was retrospectively analyzed.Three hospitals were selected according to the ratio of about 7∶3 in the original data then selected their patients as the training set with a total of 294 samples,and the remaining two hospitals were included as the validation set with a total of 110 samples.The independent risk factors of poor prognosis in elderly patients with CRE pulmonary infection were analyzed by LASSO regression and COX multivariate regression model.The patients in training set were divided into low-risk group and high-risk group according to the independent risk factors.The prognostic prediction model was established and verified by R(4.2.1)software according to the independent risk factors and risk groups.Results Tracheal intubation,gastric tube placement,malnutrition,Chronic Obstructive Pulmonary Disease and shock were the independent risk factors for poor prognosis of pulmonary infection in elderly patients with CRE(all P<0.05).The prediction model was constructed and verified by the 5 risk factors and risk grouping.The verification results showed that:The area under the ROC curve of training set and validation set were 0.821 and 0.806 respectively,which indicated that the model had good diagnostic ability.The calibration curve analysis showed that the model fitted well.The decision curve analysis showed that the model was beneficial.Conclusions The probability of poor prognosis in elderly patients with CRE pulmonary infection can be individually predicted by nomogram model.

关 键 词：肺炎 细菌性 肠杆菌科 预后 预测 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统] R446.5[医药卫生—内科学]