影响重症肺炎患者支气管镜灌洗治疗频率的因素及风险预测模型构建

Factors affecting the frequency of bronchoscopic lavage treatment in patients with severe pneumonia and the construction of risk prediction models

目的分析重症肺炎患者支气管镜灌洗治疗频率的影响因素,并构建风险预测模型。方法回顾性收集2020年1月至2022年12月于信阳市传染病医院接受支气管镜灌洗治疗的110例重症肺炎患者临床资料,依据支气管镜灌洗治疗频率将患者分为单次组77例与多次组(灌洗≥2次)33例。采用Logistic回归分析影响重症肺炎患者支气管镜灌洗治疗频率的因素,并根据回归分析结果构建风险预测模型,利用R软件构建列线图,绘制受试者工作特征(ROC)曲线评估风险模型的预测效能。结果多次组年龄大于单次组,热程长于单次组,入院时急性生理与慢性健康状况评分(APACHE-Ⅱ)、C反应蛋白(CRP)水平均高于单次组,支气管阻塞患者占比高于单次组,差异均有统计学意义(P<0.05);经Logistic回归分析显示,年龄、热程、APACHE-Ⅱ评分、CRP水平及支气管阻塞为影响重症肺炎患者支气管镜灌洗治疗频率的独立危险因素(OR>1,P<0.05);绘制列线图构建重症肺炎患者支气管镜灌洗治疗频率风险预测模型,验证模型区分度显示一致性指数(C-index)值=0.903,具有良好的区分度;绘制标准曲线显示,校准曲线与Y-X直线相近,模型准确度良好。结论年龄、热程、APACHE-Ⅱ评分、CRP水平及支气管阻塞为重症肺炎患者支气管镜灌洗治疗频率的影响因素,基于上述因素构建的风险预测模型对于重症肺炎患者支气管镜需接受多次灌洗治疗的预测价值较高。

【Objective】To analyze the influencing factors of bronchoscopic lavage treatment frequency in severe pneumonia patients and construct a risk prediction model.【Methods】The clinical data of 110 patients with severe pneumonia who received bronchoscopic lavage in Xinyang Infectious Diseases Hospital from January 2020 to December 2022 were retrospectively collected.According to the frequency of bronchoscopic lavage,the patients were divided into a single group of 77 cases and a multiple group of 33 cases(no less than twice).Logistic regression analysis was used to analyze the factors that affect the frequency of bronchoscopic lavage treatment in severe pneumonia patients,and a risk prediction model was constructed based on the regression analysis results.R software was used to construct a column chart and a receiver operating characteristic(ROC)curve was drawn to evaluate the predictive effectiveness of the risk model.【Results】The multiple group was older than the single group,with a longer heat course than the single group.The Acute Physiology and Chronic Health EvaluationⅡ(APACHE-Ⅱ)score and C-reactive protein(CRP)levels at admission of the multiple group were higher than those of the single group,and the proportion of patients with bronchial obstruction in the multiple group was higher than in the single group,with statistical significant differences(P<0.05).Logistic regression analysis showed that age,heat duration,APACHE-Ⅱscore,CRP level,and bronchial obstruction were independent risk factors affecting the frequency of bronchoscopic lavage treatment in severe pneumonia patients(OR>1,P<0.05).A nomogram was drawn to construct a risk prediction model for the frequency of bronchoscopy lavage in patients with severe pneumonia.The discrimination of the model showed that the consistency index(C-index)value=0.903,with good discrimination.The standard curve showed that the calibration curve was close to the Y-X straight line,and the accuracy of the model was good.【Conclusion】Age,heat duration,APACHE-II score,CRP level,and bronchial obstruction are the influencing factors of bronchoscopy lavage treatment frequency in severe pneumonia patients.The risk prediction model constructed based on these factors has high predictive value for the need for multiple lavage treatments in bronchoscopy for severe pneumonia patients.