构建风险模型预测慢性心力衰竭患者发生院内获得性肺炎的风险  

Building a risk model to predict the risk of hospital acquired pneumonia in patients with chronic heart failure

作　　者：麦苗 张园园 李闰梅 符惠丽 MAI Miao;ZHANG Yuanyuan;LI Runmei;FU Huili(The First Affiliated Hospital of Hainan Medical College,Haikou,Hainan 570102,China)

机构地区：[1]海南医学院第一附属医院心内科,海南海口570102

出　　处：《热带医学杂志》2024年第4期574-578,共5页Journal of Tropical Medicine

基　　金：海南省卫生健康行业科研项目(21A200083)。

摘　　要：目的分析慢性心力衰竭患者发生院内获得性肺炎的情况,构建logistic风险预测模型。方法收集2018年1月-2022年3月在海南医学院第一附属医院心血管内科住院治疗的652例慢性心力衰竭患者的临床资料,分析慢性心力衰竭患者发生院内获得性肺炎病原菌分布,单因素及多因素logistic回归分析慢性心力衰竭患者发生院内获得性肺炎的危险因素,采用logistic回归分析建立慢性心力衰竭患者发生院内获得性肺炎风险预测模型,采用受试者工作特征(ROC)曲线评估该模型的预测效果。结果652例病例中有123例发生院内获得性肺炎,感染病原菌以革兰阴性菌为主(68.10%)。单因素和多因素logistic回归分析结果显示,年龄≥75岁(OR=1.586,95%CI:1.011~2.488)、心力衰竭控制超过3 d(OR=1.718,95%CI:1.042~2.834)、使用无创呼吸机>3 d(OR=1.613,95%CI:1.014~2.565)、合并中等量以上胸腔积液(OR=1.634,95%CI:1.057~2.525)、合并吞咽功能障碍[OR=4.580,95%CI:2.467~8.499)]及住院时间>7 d(OR=1.853,95%CI:1.126~3.051)是慢性心力衰竭患者发生院内获得性肺炎的独立危险因素。回归模型拟合度良好(Hosmer-Leme-show检验,χ^(2)=9.755,P=0.203),预测发生院内获得性肺炎具有良好的预测效能(AUC=0.735,95%CI:0.687~0.782)。结论年龄、心力衰竭控制时间、使用无创呼吸机时间、胸腔积液、吞咽功能障碍及住院时间均是慢性心力衰竭患者发生院内获得性肺炎的影响因素,通过建立多因素logistic风险预测模型可较准确预测慢性心力衰竭患者发生院内获得性肺炎的发生,进而指导临床干预工作。Objective To investigate the incidence of nosocomial pneumonia in patients with chronic heart failure and construct a logistic risk prediction model.Methods The clinical data of 652 patients with chronic heart failure hospitalized in the Department of cardiovascular medicine of the First Affiliated Hospital of Hainan Medical College from January 2018 to March 2022 were analyzed retrospectively.The distribution of pathogens of nosocomial pneumonia in patients with chronic heart failure was analyzed.The risk factors of nosocomial pneumonia in patients with chronic heart failure were investigated by univariate and multivariate logistic regression analysis.Logistic regression analysis was used to establish a prediction model for investigating the risk of nosocomial pneumonia in patients with chronic heart failure.The receiver operating characteristic(ROC)curve was used to evaluate the prediction effect of the model with the area under the curve(AUC).Results A total of 123 out of the 652 cases developed nosocomial pneumonia,and the main pathogens were gram⁃negative bacteria(68.10%).Univariate and multivariate logistic regression analysis showed that age≥75 years old(OR=1.586,95%CI:1.011-2.488),heart failure control for more than 3 days(OR=1.718,95%CI:1.042-2.834),use of noninvasive ventilator for more than 3 days(OR=1.613,95%CI:1.014-2.565),combined with moderate or more pleural effusion(OR=1.634,95%CI:1.057-2.525),combined with swallowing dysfunction(OR=4.580,95%CI:2.467-8.499)and hospital stay for more than 7 days(OR=1.853,95%CI:1.126-3.051)were independent risk factors for nosocomial pneumonia in patients with chronic heart failure.The regression model fit well(Hosmer⁃Leme⁃show test,χ^(2)=9.755,P=0.203)and predicted hospital acquired pneumonia(AUC=0.735,95%CI:0.687-0.782).Conclusions Age,heart failure control,non⁃invasive ventilation,pleural effusion,swallowing dysfunction,and hospital stay were all influencing factors for the occurrence of hospital acquired pneumonia in patients with chronic heart failu

关 键 词：慢性心力衰竭 院内获得性肺炎 风险预测模型 

分 类 号：R541.6[医药卫生—心血管疾病]