老年急性左心衰并发肺部感染病原菌与危险因素及其预测模型的预测价值

Pathogenic bacteria and risk factors for pulmonary infections complicating acute left heart failure in the elderly and the predictive value of their predictive models

目的探讨老年急性左心衰并发肺部感染病原菌与危险因素及其预测模型的预测价值.方法回顾性分析2020年1月-2022年7月连云港市第一人民医院收治的116例老年急性左心衰患者的临床资料,根据肺部感染情况分为感染组(65例)和未感染组(51例);统计老年急性左心衰患者并发肺部感染的病原菌,并归纳肺部感染的危险因素,并构建预测模型,采用受试者工作特征(ROC)曲线分析预测模型对老年急性左心衰患者并发肺部感染的预测价值.结果65例老年急性左心衰肺部感染患者共培养分离病原菌51株,其中真菌3株占5.88%,革兰阳性菌16株占31.37%,革兰阴性菌32株占62.74%;年龄、合并糖尿病、抗菌药物和激素滥用史、心功能分级Ⅳ级是老年急性左心衰患者并发肺部感染的危险因素(P<0.05).构建预测模型:logit(P)=-10.673+年龄×1.011+合并糖尿病×0.978+抗菌药物和激素滥用史×1.033+心功能分级Ⅳ级×0.896;ROC曲线分析结果显示,预测模型预测老年急性左心衰患者并发肺部感染的曲线下面积(AUC)为0.841,敏感度为69.23%,特异度为80.39%.结论老年急性左心衰患者并发肺部感染的病原菌以革兰阴性菌为主,且感染的危险因素包括年龄、合并糖尿病、抗菌药物和激素滥用史、心功能分级Ⅳ级,据此建立预测模型对老年急性左心衰患者并发肺部感染具有较好的预测价值.

OBJECTIVE To investigate the pathogenic bacteria and risk factors of pulmonary infections complicating acute left heart failure in the elderly and the predictive value of their predictive models.METHODS The clinical da-ta of 116 elderly patients with acute left heart failure admitted to Lianyungang City First People's Hospital from Jan.2020 to Jul.2022 were retrospectively analyzed,and the patients were divided into the infection group(65 ca-ses)and the non-infection group(51 cases)according to the pulmonary infection status.The pathogenic bacteria of pulmonary infections in elderly patients with acute left heart failure were counted,and the risk factors for pulmo-nary infections were summarized,and a prediction model was constructed,and the predictive value of the predic-tion model for elderly patients with acute left heart failure complicated with pulmonary infection was analyzed u-sing the receiver operating characteristics(ROC)curve.RESULTS A total of 51 strains of pathogenic bacteria were culturally isolated from 65 elderly patients with acute left heart failure complicated with pulmonary infection,of which 3 strains of fungi accounted for 5.88%,16 strains of gram-positive bacteria accounted for 31.37%,and 32 strains of gram-negative bacteria accounted for 62.74%.Age,comorbidity with diabetes mellitus,history of anti-biotic and hormone abuse,and cardiac function classⅣwere the risk factors for the complication of pulmonary in-fections in elderly patients with acute left heart failure(P<0.05).The predictive model was constructed as fol-lows:logit(P)=-10.673+age≥80 years×1.011+diabetes mellitus×0.978+history of antibiotic and hor-mone abuse×1.033+cardiac function gradeⅣ×0.896.ROC analysis showed that the area under the curve(AUC)of the predictive model for predicting pulmonary infection in elderly patients with acute left heart failure was 0.841,with the sensitivity of 69.23%and the specificity of 80.39%.CONCLUSION Gram-negative bacteria were the main pathogens of pulmonary infection in elderly patients with acute left heart failure,and the risk fac-tors for infections included age,comorbid diabetes mellitus,a history of antibiotic and hormone abuse,and cardiac function classⅣ,according to which the established prediction model for pulmonary infection in elderly patients with acute left heart failure had a good predictive value.