急性呼吸衰竭患者发生胃肠功能障碍的危险因素及预测模型的构建分析

Analysis of risk factors and predictive model of gastrointestinal dysfunction in patients with acute respiratory failure

目的分析急性呼吸衰竭(ARF)患者发生胃肠功能障碍的危险因素并构建预测模型。方法选择2018年8月—2022年8月西安交通大学第二附属医院急诊科收治的老年ARF患者452例,采用急性胃肠功能障碍(AGI)评分评估患者胃肠道功能并分为无障碍组136例和障碍组316例。收集患者临床资料,采用二元Logistic回归分析老年ARF患者发生胃肠功能障碍的危险因素,基于危险因素构建老年ARF患者发生胃肠功能障碍的预测模型。Hosmer-Lemeshow(H-L)检验、受试者工作特征曲线(ROC)检验预测模型的校准度和区分度。结果AGI分级1级136例,2级152例,3级101例,4级63例,共316例发生胃肠道功能障碍,胃肠道功能障碍发生率为69.91%。2组年龄、ARF病因、腹腔感染、营养支持、ICU住院时间、APACHEⅡ评分、SOFA评分、PCT、CRP、DAO、D-乳酸、IFABP等比较差异有统计学意义(P<0.05)。年龄大、脓毒症、SOFA评分高、D-乳酸高、IFABP高是老年ARF患者发生胃肠功能障碍的危险因素[OR(95%CI)=2.273(1.480~3.491)、2.175(1.467~3.225)、1.900(1.294~2.790)、1.540(1.173~2.023)、1.489(1.158~1.913)]。预测模型预测老年ARF患者发生胃肠功能障碍的曲线下面积为0.840(95%CI 0.803~0.873,P<0.05),H-L检验P=0.109。根据回归系数计算危险因素的预测得分,其最佳临界值为2分,曲线下面积为0.848(95%CI 0.811~0.880,P<0.05)。结论年龄大、脓毒症、SOFA评分高、D-乳酸高、IFABP高是老年ARF患者胃肠道功能障碍的危险因素,据此建立预测模型具有较好的预测效能。

Objective To analyze the risk factors of gastrointestinal dysfunction in patients with acute respiratory failure(ARF)and build a prediction model.Methods Four hundred and fifty-two elderly patients with ARF who were admitted to the Emergency Department of the Second Affiliated Hospital of Xi'an Jiaotong University from August 2018 to August 2022 were selected.The gastrointestinal function of the patients was evaluated with acute gastrointestinal dysfunction(AGI)score and divided into 136 cases in the non-obstacle group and 316 cases in the obstacle group.Collect clinical data from patients,use binary logistic regression to analyze the risk factors for gastrointestinal dysfunction in elderly ARF patients,and construct a predictive model for gastrointestinal dysfunction in elderly ARF patients based on these risk factors.The Hosmer Lemeshow(H-L)test and the Receiver Operating Characteristic Curve(ROC)test are used to test the calibration and discrimination of the predictive model.Results There were 136 cases with AGI grade 1,152 cases with AGI grade 2,101 cases with AGI grade 3,and 63 cases with AGI grade 4.A total of 316 cases developed gastrointestinal dysfunction,with an incidence rate of 69.91%.There was a statistically significant difference in age,ARF etiology,abdominal infection,nutritional support,ICU hospitalization time,APACHEⅡ score,SOFA score,PCT,CRP,DAO,D-lactate,and IFABP between the two groups(P<0.05).Age,sepsis,high SOFA score,high D-lactate,and high IFABP are risk factors for gastrointestinal dysfunction in elderly ARF patients[OR(95%CI)=2.273(1.480-3.491),2.175(1.467-3225),1.900(1.294-2.790),1.540(1.173-2.023),and 1.489(1.158-1.913)].The predictive model predicts that the area under the curve for gastrointestinal dysfunction in elderly ARF patients is 0.840(95%CI 0.803-0.873,P<0.05),and the H-L test P=0.109.According to the regression coefficient,the predicted score of risk factors was calculated,and the optimal critical value was 2 points.The area under the curve was 0.848(95%CI 0.811-0.880,P<0.05).Conclusion Age,sepsis,high SOFA score,high D-lactate,and high IFABP are risk factors for gastrointestinal dysfunction in elderly ARF patients.Based on this,establishing a predictive model has good predictive power.