摘要
目的 构建并验证基于老年综合征的急诊老年肺炎合并脓毒症患者28 d死亡的预测模型。方法 连续纳入2022年1月至11月就诊于北京朝阳医院急诊科年龄≧65岁的社区获得性肺炎合并脓毒症患者607例。使用R软件随机将患者分为训练集425例(70%)和测试集182例(30%)。根据随访28 d生存情况,将患者分为生存组421例和死亡组186例。记录患者的一般资料、入院时生命体征、实验室指标及老年综合征相关内容。在训练集中,采用最小绝对收缩算子回归及Cox回归进行变量筛选,确定患者28 d死亡的独立影响因素并构建列线图。通过时间依赖的受试者工作特征曲线下面积(AUC)和校准曲线在测试集中对模型的区分度和校准度进行验证。采用临床决策曲线分析(DCA)验证模型的临床有效性。结果 多因素Cox回归分析显示,近1年跌倒史(HR=1.613,CI 1.098~2.730;P=0.015)、Glasgow评分(HR=0.923,95%CI 0.880~0.968;P=0.001)、临床衰弱量表评分(HR=1.265,95%CI 1.081~1.481;P=0.003)、外周血氧饱和度(HR=0.966,95%CI 0.949~0.983;P<0.001)、乳酸(HR=1.159,95%CI 1.095~1.226;P<0.001)、白蛋白(HR=0.963,95%CI 0.930~0.998;P=0.037)、降钙素原(HR=1.010,95%CI 1.001~1.020;P=0.026)、白细胞(HR=1.028,95%CI 1.007~1.050;P=0.009)和红细胞(HR=0.731,95%CI 0.600~0.891;P=0.002)为急诊老年肺炎合并脓毒症患者28 d死亡的独立影响因素。纳入上述9个变量构建的列线图模型预测患者28 d死亡的时间依赖的AUC在训练集和测试集中均>0.80,提示该模型在训练集和测试集中均具有较好的判别能力。校准曲线显示,列线图模型在训练集和测试集中的预测概率与观察概率一致性较好。DCA证实,列线图模型在测试集及训练集中均具有较好的临床获益。结论 基于老年综合征(跌倒、衰弱和营养不良)的列线图模型可有效预测急诊老年肺炎合并脓毒症患者28 d死亡,有利于临床医生早期进行危险分层并采取干预�
Objective To construct and validate a geriatric syndrome-based prediction model for 28-day mortality in older patients with pneumonia-induced sepsis admitted in emergency department.Methods A total of 607 patients aged≥65 years with pneumonia-induced sepsis visiting the emergency department of Beijing Chaoyang Hospital from January to November 2022 were consecutively enrolled in this study.According to their survival status at 28-day follow-up,they were divided into survival group(421 cases)and death group(186 cases).With the aid of R software,they were randomly assigned into a training set(425 cases,70%)and a test set(182 cases,30%).General data,vital signs at admission,laboratory indicators and geriatric syndrome-related indicators were recorded.Least absolute shrinkage and selection operator regression and Cox regression were used to determine independent variables related to 28-day mortality in training set,and a nomogram was then constructed.Time-dependent area under receiver operating characteristic curve(AUC)and calibration curve were employed to evaluate the discriminability and calibration of the model,respectively.Decision curve analysis(DCA)was applied for clinical effectiveness of the model.Results Multivariate Cox regression analysis indicated that the history of falls in the past year(HR=1.613,95%CI 1.098-2.730;P=0.015),Glasgow coma scale(HR=0.923,95%CI 0.880-0.968;P=0.001),score of clinical frailty scale(HR=1.265,95%CI 1.081-1.481;P=0.003),peripheral capillary oxygen saturation(HR=0.966,95%CI 0.949-0.983;P<0.001),levels of lactate(HR=1.159,95%CI 1.095-1.226;P<0.001),albumin(HR=0.963,95%CI 0.930-0.998;P=0.037)and procalcitonin(HR=1.010,95%CI 1.001-1.020;P=0.026),and counts of white blood cells(HR=1.028,95%CI 1.007-1.050;P=0.009)and red blood cells(HR=0.731,95%CI 0.600-0.891;P=0.002)were independent influencing factors for 28-day mortality among older patients with pneumonia-induced sepsis.The time-independent AUC value of our nomogram based on above 9 variables was>0.80 in predicting 28-day mortal
作者
商娜
李秋敬
刘慧珍
封晓琳
张放
郭树彬
Shang Na;Li Qiujing;Liu Huizhen;Feng Xiaolin;Zhang Fang;Guo Shubin(Clinical Research Center for Emergency Medicine,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Emergency Medicine,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of Emergency Medicine,China Rehabilitation Research Center,Beijing 100068,China;Comprehensive Treatment Unit,Fifth Medical Center,Chinese PLA General Hospital,Beijing 100071,China)
出处
《中华老年多器官疾病杂志》
2024年第6期460-465,共6页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
心肺脑复苏北京市重点实验室2020年开放课题(2020XFN-KFKT-02)
吴阶平医学基金会临床科研专项资助基金(320.6750.2022-26-14)。
关键词
老年人
肺炎
脓毒症
急诊科
预测模型
aged
pneumonia
sepsis
emergency department
prediction model
