老年慢性心力衰竭合并肺部感染患者预后不良的列线图预测模型构建  

Nomogram model of poor prognosis in elderly patients with chronic heart failure complicated with pulmonary infection

作　　者：吕佳楠 王亚楠 李璐 冯艳兰 Lyu Jianan;Wang Yanan;Li Lu;Feng Yanlan(Department of Critical Care Medicine,Tangdu Hospital,Airforce Medical Universdity,Xi’an Shaanxi 710038,China)

机构地区：[1]空军军医大学唐都医院重症医学科,陕西西安710038

出　　处：《中国医刊》2025年第1期14-17,共4页Chinese Journal of Medicine

基　　金：陕西省医学科学研究课题(2021JM3234)。

摘　　要：目的探讨老年慢性心力衰竭(简称心衰)合并肺部感染患者预后不良的危险因素并构建列线图预测模型。方法前瞻性选取2022年6月至2023年6月空军军医大学唐都医院收治的103例老年慢性心衰合并肺部感染患者,根据生存情况分为预后不良组(n=24)和预后良好组(n=79)。采用Lasso-Logistic回归分析筛选老年慢性心衰合并肺部感染患者预后不良的独立危险因素,并据此构建列线图预测模型,采用校准曲线和受试者操作特征(ROC)曲线验证模型的预测效能及临床应用潜力。结果103例老年慢性心衰合并肺部感染患者中,预后不良24例,占23.30%。Lasso-Logistic回归分析显示,高血压史、吸烟史、心功能分级、抗生素使用、住院时间、侵入性操作是老年慢性心衰合并肺部感染患者预后不良的独立危险因素(OR>1,P<0.05),据此构建列线图预测模型,校准曲线显示其C-index为0.757,ROC曲线分析显示其预测老年慢性心衰合并肺部感染患者预后不良的曲线下面积为0.759(95%CI 0.634~0.885),表明其具有较好的临床应用价值和预测效能。结论老年慢性心衰合并肺部感染患者预后不良的独立危险因素包括高血压史、吸烟史、心功能分级、抗生素使用、住院时间、侵入性操作,据此构建的列线图预测模型能够较为可靠地评估患者的预后。Objective To explore the key points of protection for elderly patients with chronic heart failure complicated with pulmonary infection,and to construct a Nomogram model of their prognosis.Method From June 2022 to June 2023,103 elderly patients with chronic heart failure complicated with pulmonary infection were selected and divided into poor prognosis group(n=24)and good prognosis group(n=79)according to their survival conditions.Lasso-Logistic regression was used to analyze the prognostic factors of senile chronic heart failure complicated with pulmonary infection.According to the prognostic factors,Nomogram prediction model was constructed,and the predictive effi cacy and clinical application potential of nomograms model were verifi ed by receiver operating characteristics(ROC)curve and calibration curve.Result Among 103 elderly patients with chronic heart failure complicated with pulmonary infection,24 cases had poor prognosis,accounting for 23.30%.There was no difference in age,sex,BMI,course of disease,previous surgical history,drinking history,diabetes and regular vaccination between the two groups(P>0.05).There were differences in hypertension,smoking history,cardiac function classifi cation,antibiotic use,hospitalization time and invasive operation(P<0.05).Lasso-Logistic regression analysis showed that hypertension,smoking history,cardiac function classifi cation,antibiotic use,hospitalization time and invasive operation were all infl uencing factors of poor prognosis of elderly chronic heart failure complicated with pulmonary infection(OR>1,P<0.05).The ROC curve shows that the AUC values of hypertension,smoking history,cardiac function classification,antibiotic use,hospitalization time and invasive operation are all above 0.600,which shows that the above indexes have good predictive value for the poor prognosis of elderly chronic heart failure complicated with pulmonary infection.Conclusion Hypertension,smoking history,cardiac function classifi cation,antibiotic use,hospitalization time and invasive oper

关 键 词：慢性心力衰竭 肺部感染 列线图预测模型 预后不良 

分 类 号：R541.6[医药卫生—心血管疾病]