活动性肺结核合并重症肺炎患者死亡相关危险因素分析及风险预测模型构建

Analysis of risk factors associated with mortality and construction of a risk prediction model for patients with active pulmonary tuberculosis complicated with severe pneumonia

目的了解活动性肺结核合并重症肺炎患者发生死亡的独立危险因素,以此构建该类患者死亡的早期预测模型并分析其预测价值。方法回顾性收集2019年10月至2021年10月成都市公共卫生临床医疗中心重症监护室收治的400例活动性肺结核合并重症肺炎患者为研究对象,以7∶3的比例随机分为建模组(280例)和验证组(120例),按照30 d预后,将建模组分为存活组与死亡组,采用多因素Logistic回归分析法分析该类患者死亡的独立危险因素,并构建死亡预测模型,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,计算曲线下面积、灵敏度、特异性。采用预测模型预测验证组患者死亡发生情况,绘制ROC曲线。结果多因素Logistic回归分析显示,延迟抗结核(OR=2.312,95%CI:1.350~3.960)、白蛋白≤30 g/L(OR=1.824,95%CI:1.014~3.283)、CD4+T淋巴细胞<414个/μL(OR=2.476,95%CI:1.045~5.864)、有创机械通气(OR=5.275,95%CI:2.640~10.538)是活动性肺结核合并重症肺炎患者发生死亡的独立危险因素,以此构建的预测模型AUC为0.757(95%CI:0.703~0.806),灵敏度为0.702,特异性为0.681。在验证组中验证该模型的曲线下面积为0.724(95%CI:0.635~0.801),灵敏度为0.612,特异性为0.690。结论延迟抗结核、白蛋白≤30 g/L、CD4+T淋巴细胞<414个/μL、有创机械通气是活动性肺结核合并重症肺炎患者发生死亡的独立危险因素,基于以上因素建立的死亡风险预测模型对该类患者早期预后判断及临床干预具有一定临床价值。

Objective To investigate the independent risk factors of death in patients with active pulmonary tuberculosis complicated with severe pneumonia,so as to construct an early prediction model for mortality in these patients and analyze its predictive value.Methods A retrospective analysis was conducted on 400 patients with active pulmonary tuberculosis complicated with severe pneumonia in the intensive care unit of Public Health Clinical Center of Chengdu from October 2019 to October 2021.The patients were randomly divided into a model group(280 cases)and a verification group(120 cases)in a ratio of 7∶3.According to the 30-day prognosis,the model group was divided into a survival group and a death group.The independent risk factors affecting the death of these patients were identified by binary multivariate Logistic regression analysis,and a mortality prediction model was constructed.Receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC),sensitivity and specificity were calculated.The prediction model was used to predict the death of the patients in the verification group,and the ROC curve was drawn.Results Binary multivariate Logistic regression analysis showed that delayed antituberculosis treatment(OR=2.312,95%CI:1.350-3.960),albumin≤30 g/L(OR=1.824,95%CI:1.014-3.283),CD4+T lymphocytes<414 cells/μL(OR=2.476,95%CI:1.045-5.864)and invasive mechanical ventilation(OR=5.275,95%CI:2.640-10.538)were independent risk factors for death in patients with active pulmonary tuberculosis complicated with severe pneumonia.The AUC was 0.757(95%CI:0.703-0.806)with a sensitivity of 0.702 and a specificity of 0.681.In the verification group,the AUC of the model was 0.724(95%CI:0.635-0.801)with a sensitivity of 0.612 and a specificity of 0.690.Conclusions Delayed antituberculosis treatment,albumin≤30 g/L,CD4+T lymphocytes<414 cells/μL,and invasive mechanical ventilation are independent risk factors for the death of patients with active pulmonary tuberculosis complicated with severe pneumonia.The death risk prediction model based on the above factors has certain clinical value for early prognosis assessment and clinical intervention of these patients.