烧伤患者医院获得性肺炎风险早期预测模型的建立及其预测价值

Establishment of the early prediction model for hospital-acquired pneumonia in burn patients and and its predictive value

目的 分析烧伤患者医院获得性肺炎(HAP)的危险因素并构建风险早期预测模型。方法 选取2019年1月1日—2021年12月31日赣州市人民医院创伤急救中心收治的733例烧伤患者为研究对象,随机数字表法按照大约7∶3的比例分成建模组(519例)和验证组(214例),采用单因素和多因素logistic回归分析烧伤患者并发HAP的危险因素,并依此构建预测模型,绘制受试者工作特征(ROC)曲线对模型进行验证。结果 733例患者中98例发生HAP,发生率为13.37%;痰培养分离出132株病原菌,以革兰阴性菌为主;多因素logistic回归分析显示,烧伤总面积、合并吸入性损伤、机械通气天数是烧伤患者并发HAP的独立危险因素(P<0.05);依此构建预测模型并进行验证,结果显示,建模组和验证组的ROC曲线下面积分别为0.832(95%CI:0.790~0.874)和0.709(95%CI:0.620~0.798)。结论 烧伤总面积、合并吸入性损伤、机械通气天数是烧伤患者并发HAP的独立危险因素,基于此构建的烧伤患者HAP风险早期预测模型,对创伤急救中心烧伤患者发生HAP前的治疗和预防具有一定的预测价值。

OBJECTIVE To analyze the risk factors of hospital-acquired pneumonia(HAP) in burn patients and construct an early risk prediction model. METHODS A total of 733 burn patients admitted to the trauma emergency center of Ganzhou people′s Hospital from Jan. 1, 2019 to Dec. 31, 2021 were selected as the research objects, and were divided into a modeling group(519 cases) and a validation group(214 cases) according to a ratio of 7∶3 by the random number table method. Univariate analysis and logistic regression were used to analyze the risk factors of burn patients complicated with hospital-acquired pneumonia, and a predictive model was constructed accordingly, and the receiver operating characteristic(ROC) curve was drawn to verify the model. RESULTS Ninety-eight cases of the 733 patients developed hospital-acquired pneumonia, with an incidence rate of 13.37%. 132 strains of pathogenic bacteria were isolated from sputum culture, mainly Gram-negative bacteria. Multivariate logistic regression analysis showed that total burn area, combined inhalation injury, and days of mechanical ventilation were the independent risk factors for burn patients complicated with HAP(P<0.05). A predictive model was constructed and validated based on this, which showed that the area under curve(AUC) of the modeling group and the validation group were 0.832(95%CI: 0.790-0.874) and 0.709(95%CI: 0.0.620-0.798), respectively. CONCLUSION The total burn area, combined with inhalation injury and days of mechanical ventilation were the independent risk factors of HAP infection in burn patients. The early prediction model of hospital-acquired pneumonia risk in burn patients based on this model had certain predictive value for the treatment and prevention of HAP in burn patients in trauma emergency center.