基于DynNom动态评分构建老年重症肺炎并发呼吸衰竭的风险预测模型

Development of a risk prediction model for respiratory failure in elderly patients with severe pneumonia based on DynNom dynamic scoring

    摘要
  • 摘要: 目的 基于DynNom动态评分构建老年重症肺炎并发呼吸衰竭的风险预测模型。方法 选取2021年1月-2024年1月于上海中医药大学附属上海市第七人民医院收治的205例老年重症肺炎患者作为研究对象。根据呼吸衰竭发生情况将患者分为呼吸衰竭组(n=91)和非呼吸衰竭组(n=114)。采用Lasso回归分析筛选变量,采用多因素logistic回归分析老年重症肺炎并发呼吸衰竭的危险因素,并建立DynNom动态评分预测模型。结果 老年重症肺炎患者呼吸衰竭的发生率为44.39%。多因素logistic回归分析显示,氧合指数(OR:0.911,95%CI:0.880~0.944)、血清前清蛋白(PAB)(OR:0.986,95%CI:0.976~0.995)、红细胞体积分布宽度(RDW)(OR:1.515,95%CI:1.232~1.863)、C-反应蛋白(CRP)(OR:1.061,95%CI:1.021~1.102)和白细胞介素-6(IL-6)(OR:1.011,95%CI:1.005~1.017)老年重症肺炎并发呼吸衰竭的影响因素(P<0.05)。DynNom模型验证结果:C-index为0.853(95%CI:0.825~0.881);校准曲线显示,模型的校准曲线趋近于理想曲线,Hosmer-Lemeshow拟合度检验结果为(χ2=10.829,P=0.212);受试者工作特征(ROC)曲线下面积(AUC)为0.857(95%CI:0.814~0.887),Bootstrap法重复抽样1 000次内部验证的AUC为0.855(95%CI:0.809~0.901);净获益曲线显示,当预测值在8%~98%时,模型净获益率>0。结论 基于上述因素构建的DynNom动态评分预测模型对老年重症肺炎呼吸衰竭的发生风险具有一定的预测价值。

     

    Abstract: OBJECTIVE To develop a risk prediction model for respiratory failure in elderly patients with severe pneumonia based on DynNom dynamic scoring. METHODS A total of 205 elderly patients with severe pneumonia admitted to Shanghai Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from Jan. 2021 to Jan. 2024 were selected as the study subjects. Patients were divided into a respiratory failure group (n=91) and a non-respiratory failure group (n=114) based on the occurrence of respiratory failure. Lasso regression analysis was used to screen variables, and multivariate logistic regression analysis was employed to identify risk factors for respiratory failure in elderly patients with severe pneumonia and establish a DynNom dynamic scoring prediction model. RESULTS The incidence rate of respiratory failure in elderly patients with severe pneumonia was 44.39%. Multivariate logistic regression analysis revealed that oxygenation index (OR: 0.911, 95%CI: 0.880-0.944), serum prealbumin (PAB) (OR: 0.986, 95%CI: 0.976-0.995), red blood cell volume distribution width (RDW) (OR: 1.515, 95%CI: 1.232-1.863), C-reactive protein (CRP) (OR: 1.061, 95%CI: 1.021-1.102) and interleukin-6 (IL-6) (OR: 1.011, 95%CI: 1.005-1.017) were influencing factors for respiratory failure in elderly patients with severe pneumonia (P<0.05). Validation results of the DynNom model: The C-index was 0.853 (95%CI: 0.825-0.881). The calibration curve showed that the model's calibration curve approached the ideal curve, with a Hosmer-Lemeshow goodness-of-fit test result of (χ2=10.829, P=0.212). The area under the receiver operating characteristic (ROC) curve (AUC) was 0.857 (95%CI: 0.814-0.887), and the AUC for internal validation through 1 000 Bootstrap-based repeated samplings was 0.855 (95%CI: 0.809-0.901). The net benefit curve indicated that when the predicted value ranged from 8% to 98%, the model's net benefit rate was >0. CONCLUSION The DynNom dynamic scoring prediction model developed based on the aforementioned factors has certain prediction value for the risk of respiratory failure in elderly patients with severe pneumonia.

     

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