严重多发伤患者并发急性呼吸窘迫综合征的影响因素及其列线图预测模型构建

Influencing factors of concurrent acute respiratory distress syndrome in patients with serious multiple injuries and the construction of a column chart prediction model

目的分析严重多发伤(SMI)患者并发急性呼吸窘迫综合征(ARDS)的影响因素,并构建列线图。方法选择2022年6月至2023年12月本院收治的108例SMI患者,根据并发ARDS情况分为并发ARDS组(n=44)、未并发ARDS组(n=64),用Logistic回归分析筛选危险因素,绘制列线图并评估其区分度、一致性。结果108例SMI患者44例(40.74%)并发ARDS。吸烟(95%CI=1.548~12.688,P=0.006)、有肺挫伤(95%CI=1.478~11.680,P=0.007)、合并创伤性脑损伤(95%CI=1.542~19.386,P=0.009)、有腹腔脏器损伤(95%CI=1.597~18.015,P=0.007)、输注红细胞≥10U(95%CI=1.494~10.260,P=0.005)是SMI患者并发ARDS的独立危险因素。ROC曲线下面积0.818(95%CI:0.740~0.896)。校准曲线斜率接近1,且Hosmer-Lemeshow拟合优度检验χ^(2)=7.148,P=0.414。结论吸烟、有肺挫伤、合并创伤性脑损伤、有腹腔脏器损伤、输注红细胞≥10U是SMI患者并发ARDS的独立危险因素,基于上述因素构建的列线图对并发ARDS有较好预测价值。

Objective To analyze the influencing factors of concurrent acute respiratory distress syndrome(ARDS)in patients with serious multiple injuries(SMI)and construct a column chart.Methods From June 2022 to December 2023,108 SMI patients who visited our hospital were included and divided into the concurrent ARDS group(n=44)and the non concurrent ARDS group(n=64)based on their concurrent ARDS status.Logistic regression analysis was used to screen for risk factors,a column chart was drawn and the discrimination and consistency were evaluated.Conclusion 44 cases out of 108 SMI patients(40.74%)developed concurrent ARDS.Smoking(95%CI=1.548~12.688,P=0.006),pulmonary contusion(95%CI=1.478~11.680,P=0.007),concomitant traumatic brain injury(95%CI=1.542~19.386,P=0.009),abdominal organ injury(95%CI=1.597~18.015,P=0.007),and infusion of red blood cells≥10U(95%CI=1.494~10.260,P=0.005)were independent risk factors for concurrent ARDS in SMI patients.The area under the ROC curve was 0.818(95%CI:0.740-0.896).The slope of the calibration curve was close to 1,and the Hosmer-Lemeshow goodness of fit test showedχ^(2)=7.148,P=0.414.Conclusion Smoking,pulmonary contusion,combined traumatic brain injury,abdominal organ injury,and infusion of red blood cells≥10U are independent risk factors for concurrent ARDS in SMI patients.A column chart based on these factors has good predictive value for concurrent ARDS.