Effect of delirium on prognosis of elderly patients with severe pneumonia undergoing mechanical ventilation and construction of a prediction model
Objective To analyze the influence of delirium on the prognosis of elderly patients with severe pneumo-nia(SP)undergoing mechanical ventilation,and to construct a prediction model for the occurrence of delirium.Meth-ods Three hundred and ninety-seven cases of SP patients undergoing mechanical ventilation were selected and were clas-sified into the delirium group(80 cases)and non-delirium group(317 cases)according to the occurrence of delirium dur-ing the hospitalization period.The patients were followed up for 28 days starting from their admission to the intensive care unit(ICU).The 28-d cumulative survival rates of the two groups were compared,and the clinical data of the two groups were collected.Multivariate Logistic regression was used to analyze the risk factors for the occurrence of delirium during the hospitalization period in elderly SP patients undergoing mechanical ventilation and we constructed a risk prediction model.The value of the risk prediction model in predicting the occurrence of delirium in elderly SP patients was analyzed by the receiver operating characteristic(ROC)curve.Results The 28-day cumulative survival rate of the delirium group was 45.00%(36/80),which was lower than that[14.20%(45/317)]of the non-delirium group,with statistically signifi-cant difference(P<0.05).Univariate analysis showed that the severity of disease,the proportion of diabetes mellitus,the proportion of cerebrovascular disease,blood lactate,C-reactive protein(CRP),and procalcitonin(PCT)levels were higher in the delirium group than in the non-delirium group,and the ICU time,mechanical ventilation time,and time to arousal after discontinuation of medication were longer than those in the non-delirium group,and the hemoglobin level was lower than that in the non-delirium group(all P<0.05).Multifactorial Logistic regression analysis showed that high-risk condi-tion,cerebrovascular disease,diabetes mellitus,prolonged mechanical ventilation,prolonged arousal time after discontin-uation of medication,elevated blood lactate,elevated CRP,and elevated PCT were the independent risk factors for deliri-um in elderly patients with SP undergoing mechanical ventilation(all P<0.05).The risk prediction model for the occur-rence of delirium in elderly patients with SP undergoing mechanical ventilation:Ln(P/1-P)=-15.475+1.165×severity of illness+1.019×diabetes mellitus+1.476×cerebrovascular disease+0.008×duration of mechanical ventilation+0.103×time of arousal after discontinuation of medication+0.751×blood lactate+0.011×CRP+0.362×PCT(χ2=7.996,P=0.434).The ROC curve showed that the area under the curve of the risk prediction model in predicting the occurrence of delirium in elderly SP patients undergoing mechanical ventilation was 0.929(95%CI:0.899-0.952),with a optimal cut-off value of 0.217,a sensitivity of 83.75%,a specificity of 86.44%,and the maximum Youden index of 0.702,respec-tively.Conclusions Delirium will increase the risk of death in elderly SP patients.A prediction model is successfully constructed based on the risk factors for delirium in elderly SP patients undergoing mechanical ventilation,and this model has a high predictive value.
deliriumsevere pneumoniathe agedmechanical ventilationprognosisprediction model
万方数据
维普
