儿童人腺病毒7型肺炎临床预后不良的危险因素分析及相关预测模型构建

Analysis of risk factors for poor clinical prognosis in children with human adenovirus type 7 pneumonia and construction of correlative prediction model

目的探讨儿童人腺病毒7(HAdV-7)型肺炎临床预后不良的危险因素及构建相关预测模型。方法选择2018年1月至2022年1月广西壮族自治区柳州市人民医院就诊的160例HAdV-7型肺炎患儿,按照预后情况分为预后良好组(130例)和预后不良组(30例)。分析儿童HAdV-7型肺炎预后不良的危险因素,并建立风险预测模型,绘制受试者操作特征曲线检验模型预测效果。结果预后不良组发热≥38.5℃时间长于预后良好组,C反应蛋白(CRP)、乳酸脱氢酶(LDH)、降钙素原(PCT)、天冬氨酸转氨酶(AST)高于预后良好组,胸腔积液占比高于预后良好组(P<0.05)。CRP(OR=1.314)、LDH(OR=1.018)、PCT(OR=7.268)、AST(OR=1.148)、胸腔积液(OR=31.406)是儿童HAdV-7型肺炎预后不良的独立危险因素(P<0.05)。预测模型方程为Y=-43.761+0.273×CRP+0.018×LDH+1.983×PCT+0.138×AST+3.447×胸腔积液。模型的曲线下面积为0.979(95%CI:0.950~1.000),灵敏度为93.3%,特异度为95.4%,约登指数为0.887,截断值0.360。结论儿童HAdV-7型肺炎预后不良与CRP、LDH、PCT、AST、胸腔积液有关,以此构建预测模型,能有效预测儿童HAdV-7型肺炎的预后情况。

Objective To investigate the risk factors of poor clinical prognosis in children with human adenovirus type 7(HAdV-7)pneumonia and to construct the correlative prediction model.Methods A total of 160 children with HAdV-7 pneumonia treated in Liuzhou People’s Hospital of Guangxi Zhuang Autonomous Region from January 2018 to January 2022 were selected.According to the prognosis,they were divided into good prognosis group(130 cases)and poor prognosis group(30 cases).The risk factors of poor prognosis of HAdV-7 pneumonia in children were analyzed,and the risk prediction model was established,the receiver operation characteristic curve was drew to test the prediction effect of the model.Results The duration of fever≥38.5℃in poor prognosis group was longer than that in good prognosis group,C-reactive protein(CRP),lactate dehydrogenase(LDH),procalcitonin(PCT),and aspartate aminotransferase(AST)were higher than those in good prognosis group,and the proportion of pleural effusion was higher than that in good prognosis group(P<0.05).CRP(OR=1.314),LDH(OR=1.018),PCT(OR=7.268),AST(OR=1.148),and lactate dehydrogenase(LDH),procalcitonin(PCT),and aspartate aminotransferase(AST)pleural effusion(OR=31.406)were independent risk factors for poor prognosis of children with HAdV-7 pneumonia(P<0.05).The prediction model equation was Y=-43.761+0.273×CRP+0.018×LDH+1.983×PCT+0.138×AST+3.447×pleural effusion.The area under the curve of the model was 0.979(95%CI:0.950-1.000),the sensitivity was 93.3%,the specificity was 95.4%,the Yoden index was 0.887,and the cut-off value was 0.360.Conclusion The poor prognosis of children with HAdV-7 is related to CRP,LDH,PCT,AST,and pleural effusion,so the prediction model is constructed and contributed to effectively predict the prognosis of children with HAdV-7 pneumonia.