老年冠心病并发心力衰竭患者院内肺部感染影响因素及风险预测模型构建  

Influencing factors of pulmonary infection in elderly CHD patients with HF and construction of a risk prediction model for the infection

作　　者：费蕾 高明昕[1] 吴曙华[1] 陆亚琼 Fei Lei;Gao Mingxin;Wu Shuhua;Lu Yaqiong(Department of Geriatrics,Second Affiliated Hospital of Soochow University,Suzhou 215000,Jiangsu Province,China)

机构地区：[1]苏州大学附属第二医院老年科,215000

出　　处：《中华老年心脑血管病杂志》2024年第11期1277-1280,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：江苏省老年健康科研项目(LKZ2023007)。

摘　　要：目的 探讨老年冠心病伴心力衰竭患者出现院内肺部感染的影响因素。方法 回顾性选取2021年3月至2023年8月苏州大学附属第二医院老年科诊治的老年冠心病伴心力衰竭患者196例,根据住院期间有无出现肺部感染分为感染组52例和非感染组144例。采用logistic回归分析影响继发院内肺部感染的危险因素,并依据危险因素构建综合指数;采用ROC曲线分析继发院内肺部感染的诊断价值。结果 感染组年龄、纽约心脏病协会(New York Heart Association, NYHA)心功能分级Ⅲ~Ⅳ级、吸烟史、糖尿病史、机械通气时间>48 h、住院时间>14 d、入院时清蛋白<30 g/L、入院时红细胞分布宽度(red blood cell distribution width, RDW)显著高于非感染组(P<0.05,P<0.01)。Logistic回归分析显示,NYHA心功能分级Ⅲ~Ⅳ级、糖尿病史、机械通气时间>48 h、住院时间>14 d、入院时清蛋白<30 g/L、入院时RDW是影响老年冠心病伴心力衰竭患者继发院内肺部感染的危险因素(OR=2.398,95%CI:1.157~4.969;OR=2.732,95%CI:1.278~5.839;OR=2.607,95%CI:1.138~5.973;OR=3.368,95%CI:1.567~7.242;OR=2.677,95%CI:1.218~5.886;OR=1.762,95%CI:1.488~61.222)。ROC曲线分析显示,NYHA心功能分级Ⅲ~Ⅳ级、糖尿病史、机械通气时间>48 h、住院时间>14 d、入院时清蛋白<30 g/L、入院时RDW预测老年冠心病伴心力衰竭患者继发院内肺部感染的曲线下面积分别为0.598、0.620、0.586、0.595、0.615、0.850,综合指数的曲线下面积为0.743,显著优于单项指标(P<0.05)。结论 年龄、心功能NYHA分级、吸烟史、糖尿病史、机械通气时间、住院时间、入院时清蛋白、RDW水平会对老年冠心病伴心力衰竭患者继发院内肺部感染产生不良影响,依据这些危险因素构建综合指数模型对预测院内肺部感染有较高的效能。Objective To investigate the influencing factors of nosocomial pneumonia in elderly patients with CHD and HF.Methods A total of 196 elderly CHD patients with HF diagnosed and treated in our department from March 2021 to August 2023 were enrolled,and divided into infected group(n=52)and non-infected group(n=144)based on whether pulmonary infection occurred during hospitalization.Logistic regression analysis was used to identify the risk factors affecting secondary nosocomial pulmonary infection.Based on these risk factors,a comprehensive index was built.ROC curve was drawn to analyze the diagnostic value of the index for secondary nosocomial pulmonary infection.Results The infected group had significantly advanced age,larger proportions of NYHA gradeⅢtoⅣ,smoking history,diabetes history,mechanical ventilation time>48 h,length of hospital stay>14 d,and albumin at admission<30 g/L,and higher RDW at admission when compared with the non-infected group(P<0.05,P<0.01).Logistic regression analysis showed that NYHA gradeⅢtoⅣ,diabetes history,mechanical ventilation time>48 h,length of hospitalization>14 d,albumin<30 g/L at admission and RDW at admission were risk factors for secondary nosocomial pulmonary infection in elderly CHD patients with HF(OR=2.398,95%CI:1.157-4.969;OR=2.732,95%CI:1.278-5.839;OR=2.607,95%CI:1.138-5.973;OR=3.368,95%CI:1.567-7.242;OR=2.677,95%CI:1.218-5.886;OR=1.762,95%CI:1.488-61.222).ROC curve analysis indicated that the AUC value of NYHA gradeⅢtoⅣ,diabetes history,mechanical ventilation time>48 h,length of hospitalization>14 d,albumin<30 g/L at admission and RDW at admission in predicting secondary nosocomial pulmonary infection in elderly CHD patients with HF was 0.598,0.620,0.586,0.595,0.615 and 0.850,respectively,and the value of the comprehensive index was 0.743,which is superior to that of above single indicator(P<0.05).Conclusion Age,NYHA grade,smoking history,diabetes history,mechanical ventilation time,hospital stay and albumin and RDW levels at admission have adverse effects on

关 键 词：冠心病 心力衰竭 比例危险度模型 肺炎 预测 

分 类 号：R541.4[医药卫生—心血管疾病] R541.6[医药卫生—内科学]