耐碳青霉烯肺炎克雷伯菌肺炎患者共病因素与患者住院期间死亡相关因素的分析  

The relationship between comorbidity factors and in-hospital mortality in patients with carbapenem-resistant Klebsiella pneumoniae pneumonia

作　　者：王艳[1] 崔佳[1] 王丹丹[1] 葛春悦 胡云建[2] 艾效曼[2] Wang Yan;Cui Jia;Wang Dandan;Ge Chunyue;Hu Yunjian;Ai Xiaoman(Department of Respiratory and Critical Care Medicine,Beijing Hospital/National Center of Gerontology/Institute of Geriatric Medcine,Chinese Academy of Medical Science,Beijing100730,China;Department of Laboratory Medicine,Beijing Hospital/National Center of Gerontology/Institute of Geriatric Medcine,Chinese Academy of Medical Science,Beijing100730,China)

机构地区：[1]北京医院呼吸与危重症医学科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [2]北京医院检验科国家老年医学中心,中国医学科学院老年医学研究院,北京100730

出　　处：《中华预防医学杂志》2024年第11期1705-1710,共6页Chinese Journal of Preventive Medicine

基　　金：中央高水平医院临床科研业务费(BJ-2023-080)。

摘　　要：探讨耐碳青霉烯肺炎克雷伯菌(CRKP)肺炎患者共病因素与住院期间死亡的关系。本研究通过收集北京医院2011年11月至2023年12月218例CRKP肺炎患者临床资料,分析CRKP肺炎患者携带共病个数、共病模式、查尔森共病指数(CCI)评分、合并基础疾病等指标情况,探讨各指标及共病因素与CRKP肺炎患者住院期间死亡的相关性。采用Ward.D距离对患者共病病种进行聚类分析,并绘制热图。采用多因素logistic回归模型分析,构建CRKP肺炎患者住院期间死亡的预测模型列线图。本研究共纳入218例CRKP肺炎患者,结果显示,CRKP肺炎患者生存组和死亡组在年龄(P=0.003),合并心力衰竭(P<0.001)、心律失常(P=0.002)、慢性肝脏病(P=0.003)、慢性肾脏病(P=0.002),CCI评分(P=0.007),共病总个数(P<0.001)和共病模式(呼吸/免疫/精神心理疾病模式和心脑血管/肿瘤/代谢疾病模式,P=0.003)均有显著性差异。多因素logistic回归模型显示,心脑血管/肿瘤/代谢疾病模式(P=0.030),CCI评分(P=0.040),合并心力衰竭(P=0.011)、合并心律失常(P=0.025)是影响CRKP肺炎患者住院期间死亡的独立危险因素。基于以上筛选出的危险因素构建的CRKP肺炎患者住院期间死亡风险的列线图模型,ROC曲线下面积为0.758,ROC曲线和验证曲线均表明列线模型具有预测CRKP肺炎患者住院期间死亡的稳定性能。综上,共病因素是预测CRKP肺炎患者住院期间死亡的危险因素,应重视共病因素在CRKP肺炎患者住院期间死亡中所起的作用。This study aimed to explore the relationship between comorbidity factors and in-hospital mortality related to factors in patients with carbapenem-resistant Klebsiella pneumoniae(CRKP)pneumonia.This study collected clinical data from 218 patients with CRKP pneumonia in Beijing hospital from November 2011 to December 2023,analyzed the number of comorbidities carried by CRKP pneumonia patients,comorbidity patterns,Charlson Comorbidity Index(CCI)scores,and comorbidity of underlying diseases,and explored the relationship between various indicators and comorbidity factors and in-hospital mortality in CRKP pneumonia patients.The Ward.D cluster analysis was performed on the comorbidities of patients and used to draw heatmaps.Using a multiple logistic regression model,a nomogram model was constructed to predict in-hospital mortality in patients with CRKP pneumonia.This study included 218 patients with CRKP pneumonia.The results showed that there were significant differences in the age(P=0.003),comorbidities such as heart failure(P<0.001),arrhythmia(P=0.002),chronic liver disease(P=0.003),chronic kidney disease(P=0.002),CCI score(P=0.007),total number of comorbidities(P<0.001),and comorbidity patterns(respiratory/immune/psychiatric disease patterns and cardiovascular/tumor/metabolic disease patterns,P=0.003)between the survival and death groups of CRKP pneumonia patients.The multiple logistic regression showed that cardiovascular/tumor/metabolic disease patterns(P=0.030),CCI score(P=0.040),concomitant heart failure(P=0.011),and concomitant arrhythmia(P=0.025)were independent risk factors for in-hospital mortality in patients with CRKP pneumonia.The nomogram model for predicting the risk of in-hospital mortality in patients with CRKP pneumonia,constructed based on the identified risk factors,had an area under the ROC curve of 0.758.Both the ROC curve and validation curve indicated that the nomogram model had stable performance in predicting in-hospital mortality in patients with CRKP pneumonia.In summary,comorbidity factors

关 键 词：耐碳青霉烯肺炎克雷伯菌 肺炎 共病 横断面研究 住院期间死亡 

分 类 号：R563.1[医药卫生—呼吸系统]