| 李珂,李华.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[J].安徽医药,2025,29(4):804-809. |
| 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 |
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| DOI：10.3969/j.issn.1009-6469.2025.04.035 |
| 中文关键词: 肺炎 多器官功能障碍综合征 老年人 风险预测模型 列线图 |
| 英文关键词: Pneumonia Multiple organ dysfunction syndrome Elderly people Risk prediction model Nomograph |
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| 中文摘要: |
| 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。 |
| 英文摘要: |
| Objective To construct a nomogram model for risk prediction of multiple organ dysfunction syndrome (MODS) in the el.derly with severe pneumonia, and to verify the feasibility of the model.Methods The clinical data of 393 elderly patients with severepneumonia admitted to Anyang Traditional Chinese Medicine Hospital from March 2019 to November 2022 were retrospectively ana.lyzed, and the patients were assigned into model group (n=262) and validation group (n=131) according to the ratio of 2∶1. According tothe incidence of MODS in elderly patients with severe pneumonia, the model group was assigned into the concurrent group and the non-concurrent group. Logistic regression analysis was made to screen risk factors for MODS in elderly patients with severe pneumonia, andthe 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 evaluation Ⅱ (APACHEⅡ) score [(30.67±4.95) points vs. (27.30±4.55) points], clinical pul. monary 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 groupwere 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 APACHEⅡ score, CPIS, MODS score, and lev.els 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 pneu.monia. The calibration curve suggested that the calibration curve of nomogram model was consistent with the ideal curve, and the con.sistency index of model group and validation group were 0.82 and 0.80 respectively. The receiver operating characteristic curve showedthat the areas under the curve in the model group and the validation group were 0.82 and 0.82, respectively. The decision curve analy.sis results showed that elderly patients with severe pneumonia could gain net benefits from predicting the risk of MODS based on thismodel.Conclusion The nomogram model for predicting the risk of MODS in elderly patients with severe pneumonia, constructed onthe basis of APACHEⅡ score, CPIS, MODS score and levels of albumin, PCT, and blood lactic acid, has good predictive efficacy andapplicability, which can be used to screen for the risk of MODS in such patients. |
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