Construction and validation of a clinical prediction model for the progression of community-acquired pneumonia to severe pneumonia in adults
Objective To explore the risk factors affecting the progression of adult community-acquired pneumonia(CAP)to severe pneumonia(SP),construct a clinical prediction model of SP in adults,and provide a basis for early clinical identification and prediction of severe pneumonia in clinical treatment strategies.Methods The clinical data of 376 patients diagnosed with adult CAP who were hospitalized in Jinzhou Central Hospital from June 2022 to September 2023 were collected,and the enrolled cases were divided into a training set of 301 cases and a validation set of 75 cases according to the order of admission time.The CAP patients in the training set were divided into severe group and non-severe group based on discharge diagnosis.Single-factor analysis and multi-factor logistic regression analysis were used to screen predictive factors,build a prediction model for the progression of CAP to severe pneumonia,and draw a nomogram.The receiver operating characteristic(ROC)curve,calibration curve and clinical decision curve were used to evaluate the discrimination,calibration and clinical applicability of the model.Results The training set included 107 patients with severe pneumonia and 194 patients with non-severe pneumonia.Univariate analysis of each clinical index in the training set showed that consciousness disorder,pulmonary infiltration＞50％,respiratory rate,neutrophils(Neu),C-reactive protein(CRP),lactate dehydrogenase(LDH),blood sedimentation(ESR),and lactic acid(Lac)were statistically different(P＜0.05).The binary multivariate logistic regression analysis showed that,respiratory rate(OR=1.528,95％CI:1.220-1.913),Neu(OR=1.179,95％CI:1.087-1.278),CRP(OR=1.012,95％CI:1.005-1.019),LDH(OR=1.008,95％CI:1.004-1.011),ESR(OR=1.020,95％CI:1.004-1.037),the final model included these five variables as predictors to construct the model,and to plot the risk nomograms of CAP progression to severe pneumonia.The area under the ROC curve(AUC)in the training set was 0.847,95％CI:0.804-0.729(P＜0.05),and the AUC in the validation set was 0.861,95％CI:0.958-0.704.The correction curve showed that the predicted probability of progression to severe pneumonia agreed well with the observed probability,and the clinical decision curve indicated that the nomogram has clinical value.Conclusions Respiratory rate,Neu,CRP,LDH,and ESR are associated with progression to SP in adult patients with CAP.The model established based on the above factors can better predict the risk of CAP progression to SP in adults,identify and predict SP early,and provide a basis for guiding clinical treatment strategies.
Community-acquired pneumoniaSevere pneumoniaRisk prediction modelInternal and external validation
NETL
NSTL
万方数据
