含炎性指标预后预测列线图模型在儿童重症肺炎预后预测中的应用价值

Application Value of the Nomogram Model Containing Inflammatory Indicators in Predicting the Prognosis of Severe pneumonia in Children

目的 探讨含炎性指标[白细胞介素-6(IL-6)、降钙素原(PCT)、C反应蛋白(CRP)、红细胞沉降率(ESR)]预后预测列线图模型在儿童重症肺炎预后预测中的应用价值。方法 选取2021年1—10月收治的儿童重症肺炎160例,根据出院时病情恢复情况将其分为预后不良组(48例)和预后良好组(112例)2组,比较2组一般资料和炎性指标,探讨儿童重症肺炎预后不良的影响因素,构建不含与含炎性指标预后预测列线图模型,评估其预测价值及临床净获益并进行外部验证。结果 Logistic多因素回归分析结果显示,病程、哮喘病史、胸腔积液及炎性指标IL-6、PCT、CRP、ESR是儿童重症肺炎预后不良的独立危险因素,年龄和小儿危重病例评分法评分是儿童重症肺炎预后不良的独立保护因素(P<0.01)。含炎性指标预后预测列线图模型预测儿童重症肺炎预后不良的曲线下面积为0.933,95%CI为0.873,0.998,敏感度为91.67%,特异度为85.71%,优于不含炎性指标预后预测列线图模型,且该模型一致性、拟合度均较好;含炎性指标预后预测列线图模型预测值在0.4~0.9时能够提供附加临床净获益;外部验证显示,含炎性指标预后预测列线图模型预测儿童重症肺炎预后不良的曲线下面积为0.925,95%CI为0.870,0.984,敏感度为87.50%,特异度为81.82%,优于不含炎性指标预后预测列线图模型。结论 炎性指标IL-6、PCT、CRP、ESR在构建儿童重症肺炎预后预测列线图模型中具有良好应用价值,能提高预测价值与临床净获益。

Objective To explore the application value of prognostic Nomogram model containing inflammatory indicators[interleukin-6(IL-6),procalcitonin(PCT),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)]in children with severe pneumonia.Methods One hundred and sixty children with severe pneumonia admitted from January to October 2021 were selected and divided into two groups based on their recovery at discharge:a poor prognosis group(n=48)and a good prognosis group(n=112).General data and inflammatory indicators were compared between the two groups,and the influencing factors of poor prognosis in children with severe pneumonia were explored.Nomogram prediction model with and without inflammatory indicators were established,its predictive value and clinical net benefit were evaluated,and conduct external validation was conducted.Results Logistic regression analysis showed that course of disease,history of asthma,pleural effusion,and inflammatory markers IL-6,PCT,CRP,and ESR were independent risk factors for poor prognosis of severe pneumonia in children,while age and Pediatric Critical Illness Score(PCIS)score were independent protective factors for poor prognosis of severe pneumonia in children(P<0.01).The area under the curve of Nomogram model for predicting poor prognosis of severe pneumonia in children with inflammatory indicators was 0.933(95%CI 0.873,0.998),with sensitivity of 91.67%,and specificity of 85.71%,which was superior to the Nomogram model for predicting prognosis of patients without inflammatory indicators,and the model had good consistency and fit.The prognostic prediction Nomogram model with inflammatory indicators can provide additional clinical net benefits when the predicted values were between 0.4 and 0.9.External validation showed that the area under the curve of Nomogram model with inflammatory indicators in predicting poor prognosis in children with severe pneumonia was 0.925(95%CI 0.870,0.984),with sensitivity of 87.50%,and specificity of 81.82%,which was superior to Nomogram model without inflammatory indicators.Conclusion The inflammatory indicators IL-6,PCT,CRP,and ESR have good application value in constructing a Nomogram model for predicting the prognosis of severe pneumonia in children,which can improve the predictive value and clinical net benefit.