老年重症肺炎并发多器官功能障碍综合征的风险预测列线图模型构建与验证  

Construction and validation of nomogram model for risk prediction of MODS in elderly patients with severe pneumonia

作　　者：李珂 李华[1] LI Ke;LI Hua(Department of Intensive Care Medicine,Anyang Traditional Chinese Medicine Hospital,Anyang,He'nan 455000,China)

机构地区：[1]安阳市中医院重症医学科,河南安阳455000

出　　处：《安徽医药》2025年第4期804-809,共6页Anhui Medical and Pharmaceutical Journal

摘　　要：目的构建老年重症肺炎并发多器官功能障碍综合征(MODS)的风险预测列线图模型,并验证模型的可行性。方法回顾性分析2019年3月至2022年11月安阳市中医院收治的393例老年重症肺炎病人的临床资料,将病人按照2∶1比例分为模型组(n=262)和验证组(n=131)。根据老年重症肺炎病人并发MODS的情况将模型组分为并发组和未并发组,采用logistic回归分析筛选老年重症肺炎病人并发MODS的危险因素,构建风险预测列线图模型,并在验证组中评估该模型的可行性。结果发组急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分[(30.67±4.95)分比(27.30±4.55)分]、临床肺部感染评分(CPIS)[(5.97±1.03)分比(4.93±0.93)分]、MODS评分[(6.72±1.09)分比(4.98±0.99)分]及C反应蛋白、降钙素原(PCT)、血乳酸、丙氨酸转氨酶、总胆红素水平均高于未并发组(P<0.05),白蛋白和血小板计数水平低于未并发组(P<0.05)。模型组logistic回归分析结果显示,APACHEⅡ评分、CPIS、MODS评分及白蛋白、PCT、血乳酸水平均为老年重症肺炎病人并发MODS的影响因素(P<0.05)。基于以上6项风险因素建立老年重症肺炎并发MODS的风险预测列线图模型,校准曲线显示列线图模型的校准曲线和理想曲线的一致性良好,模型组和验证组的一致性指数分别为0.82、0.80;受试者操作特征曲线显示,该模型预测模型组和验证组病人MODS发生风险的曲线下面积分别为0.82、0.82;决策曲线分析结果显示,老年重症肺炎病人根据该模型预测MODS发生风险可获得净收益。结论基于APACHEⅡ评分、CPIS、MODS评分及白蛋白、PCT、血乳酸水平构建的老年重症肺炎病人并发MODS的风险预测列线图模型的预测效能及适用性较好,可用于筛查此类病人中的MODS的发生风险。Objective To construct a nomogram model for risk prediction of multiple organ dysfunction syndrome(MODS)in the elderly with severe pneumonia,and to verify the feasibility of the model.Methods The clinical data of 393 elderly patients with severe pneumonia admitted to Anyang Traditional Chinese Medicine Hospital from March 2019 to November 2022 were retrospectively analyzed,and the patients were assigned into model group(n=262)and validation group(n=131)according to the ratio of 2∶1.According to the incidence of MODS in elderly patients with severe pneumonia,the model group was assigned into the concurrent group and the nonconcurrent group.Logistic regression analysis was made to screen risk factors for MODS in elderly patients with severe pneumonia,and the risk prediction nomogram model was constructed,and the feasibility of the model was evaluated in the validation group.Results The acute physiology and chronic health evaluationⅡ(APACHEⅡ)score[(30.67±4.95)points vs.(27.30±4.55)points],clinical pulmonary infectionscore(CPIS)[(5.97±1.03)points vs.(4.93±0.93)points],MODS score[(6.72±1.09)points vs.(4.98±0.99)points],and levels of C-reactive protein,procalcitonin(PCT),blood lactic acid,alanine aminotransferase and total bilirubin in the concurrent group were all higher than those in the non-concurrent group(P<0.05),while the albumin level and platelet count were lower than those in the non-concurrent group(P<0.05).Logistic regression analysis of model group showed that APACHEⅡscore,CPIS,MODS score,and levels of albumin,PCT and blood lactic acid were all the influencing factors for MODS in elderly patients with severe pneumonia(P<0.05).Based on the above six risk factors,the risk prediction nomograph model of MODS was established in elderly patients with severe pneumonia.The calibration curve suggested that the calibration curve of nomogram model was consistent with the ideal curve,and the consistency index of model group and validation group were 0.82 and 0.80 respectively.The receiver operating charac

关 键 词：肺炎 多器官功能障碍综合征 老年人 风险预测模型 列线图 

分 类 号：R47[医药卫生—护理学]