目的 分析哮喘合并重症社区获得性肺炎(asthma combined with severe community-acquired pneumonia,As-SCAP)患儿发生不良预后(poor outcome,PO)的危险因素并构建列线图预测模型,为临床个性化治疗提供参考.方法 回顾性收集2019年9月至2023年9月青岛市市立医院儿科确诊的109例As-SCAP患儿,根据住院期间是否发生PO分为PO组和非PO组.运用Logistic回归分析确定PO的独立危险因素,根据回归系数构建列线图预测模型.采用受试者工作特征曲线(ROC)、校准曲线和决策曲线评估列线图模型的预测能力、校准能力和临床净获益.结果 PO发生率为27.52％,近3个月哮喘发作、意识状态改变、脓毒症休克、血红蛋白(Hb)＜90g·L-1、血清白蛋白(ALB)＜30 g·L-1以及中性粒细胞与淋巴细胞比值(NLR)≥ 3.5是PO发生的独立危险因素.ROC分析表明列线图模型区分度良好[AUC=0.912,95％CI(0.856,0.967)],校准曲线显示该模型拟合优度较好,决策曲线提示该模型净获益良好.结论 当As-SCAP患儿近3个月出现哮喘发作、意识状态改变、脓毒症休克、Hb＜90 g·L-1、ALB＜30 g·L-1以及NLR ≥ 3.5等危险因素时提示可能预后不良.本研究构建的As-SCAP患儿PO风险的列线图预测模型可辅助临床识别高危患者,及时采取干预措施改善预后.
Abstract
Objective To establish a nomogram prediction model and analysis the risk factors for poor outcome(PO)in children with asthma combined with severe community-acquired pneumonia(As-SCAP)to provide personalized treatment references for clinics.Methods A total of 109 As-SCAP children diagnosed from September 2019 to September 2023 in the department of pediatrics of Qingdao Municipal Hospital were retrospectively collected and divided into PO and non-PO groups according to whether PO occurred during hospitalization.Use Logistic regression analysis to determine the independent risk factors for PO,and construct a nomogram predictive model based on the regression coefficients.Receiver operating characteristic curve(ROC),calibration curve and clinical decision curve were used to evaluate the predictive ability,calibration ability and clinical net benefit of the nomogram model.Results The incidence of PO was 27.52％.Asthma attacks in recent 3 months,psychiatric symptoms,septic shock,and haemoglobin(Hb)＜90 g·L-1,neutrophil-to-lymphocyte ratio(NLR)≥3.5 and serum albumin(ALB)＜30 g·L-1 were independent risk factors of PO.ROC analysis showed that the nomogram model exhibits good discrimination[AUC=0.912,95％CI(0.856,0.967)];The calibration curve showed that the predicted probability of the model was consistent with the actual probability,the decision curve showed that the model has a good net benefit.Conclusion Risk factors such as asthma exacerbation in the last 3 months,associated psychiatric symptoms,the presence of septic shock,Hb＜90 g·L-1,ALB＜30 g·L-1,NLR≥3.5 and anaemia in children with As-SCAP suggested a possible poor prognosis.The study constructed a nomogram model to predict the risk of PO in children with As-SCAP,which can help clinicians to identify high-risk patients and taking timely interventions to improve the prognosis.
关键词
社区获得性肺炎/哮喘/哮喘合并重症社区获得性肺炎/不良预后/列线图
Key words
Community-acquired pneumonia/Asthma/Asthma combined with severe community-acquired pneumonia/Poor outcome/Nomogram
维普
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