社区获得性肺炎相关脓毒症患者住院死亡预测模型:一项回顾性队列研究  

A nomogram to predict in-hospital mortality of community-acquired pneumonia associated sepsis:a retrospective cohort study

作　　者：滕为云 曹柳兆 桑琳莉 徐兴祥 Teng Weiyun;Cao Liuzhao;Sang Linli;Xu Xingxiang(Department of Pulmonary and Critical Care Medicine,Northern Jiangsu People's Hospital Affiliated to Yangzhou University,Yangzhou 22500l,China)

机构地区：[1]扬州大学附属苏北人民医院呼吸与危重症医学科,扬州225001

出　　处：《国际呼吸杂志》2024年第10期1191-1198,共8页International Journal of Respiration

基　　金：2022年度苏北人民医院科研基金(SBHL22004、SBQN22010)。

摘　　要：目的构建并验证一种预测社区获得性肺炎(CAP)相关脓毒症患者住院死亡率的列线图。方法本研究为一项基于重症监护医疗信息数据集(MIMIC-Ⅳ)(2.0版本)的真实世界回顾性队列研究,从MIMIC-Ⅳ数据库中提取符合纳入标准和排除标准的所有患者数据。共纳入523例CAP相关脓毒症患者,并基于院内死亡情况,将所有患者分为2组:存活组(n=440)和死亡组(n=83),采用LASSO回归分析对变量进行筛选。使用筛选出的变量,建立多变量logistic逐步回归模型,并构建了列线图使模型可视化。通过自举法进行内部验证,评估模型的稳定性。绘制受试者操作特征(ROC)曲线、校准曲线和Hosmer-Lemeshow拟合度检验进行模型效能评价。使用决策曲线分析(DCA)将列线图的临床获益与常用的急性生理学评分Ⅲ(APSⅢ)、logistic器官功能障碍系统(LODS)进行比较。结果存活组男230例(52.3%),女210例(47.7%),年龄71(59,83)岁。死亡组男35例(42.2%),女48例(57.8%),年龄78(66,86)岁。2组性别构成差异无统计学意义(χ^(2)=2.85,P=0.091),死亡组年龄高于存活组(Z=3.20,P=0.001)。年龄(OR=1.04,95%CI:1.01~1.07)、体重(OR=0.98,95%CI:0.97~1.00)、转移性实体瘤(OR=4.73,95%CI:1.66~13.45)、恶性肿瘤(OR=2.09,95%CI:1.08~4.45)、心肌梗死(OR=3.06,95%CI:1.36~6.92)、体温(OR=0.65,95%CI:0.45~0.95)、阴离子间隙(OR=1.10,95%CI:1.01~1.20)、血尿素氮(OR=0.98,95%CI:0.96~1.00)、APSⅢ(OR=1.03,95%CI:1.01~1.05)、LODS(OR=1.23,95%CI:1.05~1.44)和使用血管活性药物(OR=1.74,95%CI:1.02~3.57)等参数被纳入模型,并绘制列线图。模型效能检验结果显示,ROC曲线下面积为0.878(95%CI:0.835~0.921)。校准曲线和Hosmer-Lemeshow检验表明预测结果与实际结果一致性良好(P=0.160)。DCA表明该模型在净临床益处方面优于APSⅢ和LODS评分系统。结论本研究构建的预测模型及可视化列线图具有较好的临床预测价值。ObjectiveTo create a nomogram to predict the in-hospital mortality of community-acquired pneumonia(CAP)-associated sepsis and to validate its performance.MethodsThis was a real-world retrospective cohort study based on the Medical Information Mart for Intensive Care(MIMIC-Ⅳ)(version 2.0)database involving 523 CAP-associated sepsis patients.Based on the in-hospital mortality,they were divided into the survival group(n=440)and death group(n=83).The least absolute shrinkage and selection operator(LASSO)regression analysis was used to screen variables,followed by creating a multivariable logistic stepwise regression model to visualize a nomogram to predict the in-hospital mortality of CAP-associated sepsis.Internal validation of the nomogram was performed via bootstrapping to evaluate the stability.Receiver operating characteristic(ROC)curve,calibration curve and Hosmer-Lemeshow test were used to evaluate the effectiveness.Decision curve analysis(DCA)was used to compare the clinical benefit of the nomogram with the commonly used Acute Physiology ScoreⅢ(APSⅢ),Logistic Organ Dysfunction System(LODS)in evaluating the condition of sepsis.ResultsThere were 230 males(52.3%)and 210 females(47.7%)in the survival group,aged 71(59,83)years.There were 35 males(42.2%)and 48 females(57.8%)in the death group,aged 78(66,86)years.There was no statistically significant difference in gender composition between the two groups(χ^(2)=2.85,P=0.091),and the age of the death group was higher than that of the survival group(Z=3.20,P=0.001).Age(OR=1.04,95%CI:1.01-1.07),weight(OR=0.98,95%CI:0.97-1.00),metastatic solid tumors(OR=4.73,95%CI:1.66-13.45),malignant tumors(OR=2.09,95%CI:1.08-4.45),myocardial infarction(OR=3.06,95%CI:1.36-6.92),body temperature(OR=0.65,95%CI:0.45-0.95),anion gap(AG,OR=1.10,95%CI:1.01-1.20),blood urea nitrogen(BUN,OR=0.98,95%CI:0.96-1.00),APSⅢ(OR=1.03,95%CI:1.01-1.05),LODS(OR=1.23,95%CI:1.05-1.44)and the use of vasoactive drugs(OR=1.74,95%CI:1.02-3.57)were included in the nomogram.The area under the curve(AUC

关 键 词：脓毒症 社区获得性肺炎 预测模型 住院死亡率 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]