成人重症肺炎患者并发呼吸衰竭风险调查及其预测模型研究  

Investigation on the risk of respiratory failure in severe pneumonia patients and its predictive model research

作　　者：曹伟涵 张亮 张磊 程相阁 张乐 石磊 CAO Weihan;ZHANG Liang;ZHANG Lei;CHENG Xiangge;ZHANG Le;SHI Lei(Department of(Emergency Intensive Care Unit)EICU,the Affiliate Huanghe Sanmenxia Hospital of Henan University of Science and Technology,Sanmenxia,He'nan 472000,China)

机构地区：[1]河南科技大学附属黄河医院(黄河三门峡医院)急诊重症监护室/急诊科,河南三门峡472000

出　　处：《中国热带医学》2024年第12期1540-1546,共7页China Tropical Medicine

摘　　要：目的 通过调查重症肺炎(severe pneumonia,SP)患者并发呼吸衰竭(respiratory failure,RF)风险,并建立其预测模型为SP患者个性化治疗方案制订提供参考。方法 选择2020年1月至2023年1月河南科技大学附属黄河医院(黄河三门峡医院)接诊的313例SP患者进行研究,以7∶3比例将患者分为模型组(219例)与验证组(94例)。收集可能影响SP患者并发RF的临床因素、临床评分及实验室指标。根据有无合并RF将模型组患者分为RF组与非RF组,比较2组临床因素、临床评分及实验室指标。在套索回归(least absolute shrinkage and selection operator,LASSO)筛选潜在影响因素后,以多因素logistic回归筛选出SP患者并发RF的独立性影响因素,采用R语言建立列线图模型并进行验证。结果 219例模型组患者中有115例(52.51%)出现RF,RF组与非RF在患者年龄、吸烟史、糖尿病史、机械通气情况、低蛋白血症、多重耐药菌感染、急性生理与慢性健康评分(acute physiology and chronic health score-Ⅱ,APACHE-Ⅱ)、多器官功能障碍评分(multiple organ dysfunction score,MODS)、社区获得性肺炎评分(confusion urea respiratory rate blood pressure age-65 score,CURB-65)、氧合指数(oxygenation index,OI)、血乳酸(lactate,Lac)、血小板计数(platelet,PLT)、血小板平均容积(mean platelet volume,MPV)、D二聚体(D-Dimer,D-D)、纤维蛋白原(fibrinogen,Fib)、C反应蛋白(C-reactive protein,CRP)方面差异均有统计学意义(P<0.05)。在LASSO回归基础上行多因素logistic回归分析,结果显示:低蛋白血症、多重耐药菌感染、APACHE-Ⅱ、Lac、PLT、MPV、D-D为SP患者并发RF的独立性影响因素。受试者特征曲线(receiver operating characteristic curve,ROC)分析结果显示,模型组预测SP患者并发RF的曲线下面积(area under the curve,AUC)为0.874(95%CI:0.828~0.920),验证组预测SP患者并发RF的AUC为0.841(95%CI:0.788~0.894)。霍斯黙-莱梅肖拟合优度检验(Hosmer-Lemesho,H-L)结�Objective To investigate the risk of respiratory failure(RF)in patients with severe pneumonia(SP),and to establish a prediction model to provide a reference for the development of individualized treatment plans for SP patients.Methods A study was conducted on 313 patients with SP admitted to the Affiliate Huanghe Sanmenxia Hospital of Henan University of Science and Technology from January 2020 to January 2023.Patients were divided into a model group of 219 cases and a validation group of 94 cases in a 7∶3 ratio.Clinical factors,clinical scores,and laboratory indicators that may affect RF in patients with SP were collected.According to the presence or absence of RF,the model group patients were further divided into the RF group and the non-RF group.Clinical factors,clinical scores,and laboratory indicators were compared between the two groups.Potential influencing factors were screened using least absolute shrinkage and selection operator(LASSO)regression,followed by multivariate logistic regression to identify independent influencing factors of RF in SP patients.A column chart model was established using R language and validated.Results Of 219 patients in the model group,115(52.51%)had RF.There were significant differences in age,smoking history,diabetes history,mechanical ventilation,hypoproteinemia,multidrug-resistant bacteria infection,acute physiology and chronic health score-Ⅱ(APACHE-Ⅱ),multiple organ dysfunction score(MODS),confusion urea respiratory rate blood pressure age-65 score(CURB-65),oxygenation index(OI),lactate(Lac),platelet(PLT),mean platelet volume(MPV),D-dimer(D-D),fibrinogen(Fib),and C-reactive protein(CRP)between the RF group and the non-RF group(P<0.05).The results of multivariate logistic regression analysis based on LASSO regression showed that hypoproteinemia,multidrug-resistant bacterial infection,APACHE-Ⅱ,Lac,PLT,MPV,and DD were independent influencing factors for respiratory failure in SP patients.Receiver Operating Characteristic Curve(ROC)analysis results showed that the are

关 键 词：重症肺炎 呼吸衰竭 多因素分析 列线图模型 

分 类 号：R563.1[医药卫生—呼吸系统]