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耐碳氢酶烯肺炎克雷伯杆菌肺部感染后进展为急性呼吸窘迫综合症的临床特征及Nomogram预测模型构建

Clinical Features and Nomogram Prediction Model Construction for Progression to Acute Respiratory Distress Syndrome after Carbapenem-Resistant Klebsiella pneumoniae (CRKP) Lung Infection
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摘要 目的:分析耐碳青霉烯类肺炎克雷伯杆菌(Carbapenem-resistant Klebsiella pneumoniae, CRKP)肺部感染后进展为急性呼吸窘迫综合症(Acute respiratory distress syndrome, ARDS)的临床特征以及构建Nomogram模型。方法:回顾性收集合肥市第二人民医院2019年01月~2022年12月所有肺部感染后肺泡灌洗液分离出CRKP的患者共162例,其中有71例患者CRKP肺部感染后进展为ARDS,此为ARDS组;91例患者CRKP肺部感染后未进展为ARDS,此为非ARDS组。使用SPASS 26.0软件对于收集的患者的临床资料进行单因素以及Logistic多因素分析,受试者工作特征(receiver operator char-acteristic, ROC)曲线分析各指标诊断耐CRKP肺部感染后进展为ARDS的危险因素最佳截断值以及曲线下面积(area under the ROC curve, AUC)。并以此为基础应用R软件“rms”包构建其Nomogram模型,校正曲线对Nomogram模型进行内部验证,应用R软件“rmda”包构建决策曲线,并评估Nomogram模型的预测效能。P 67.5岁)、SOFA (>1.5分)、CCI (>3.5分)是CRKP肺部感染后发生ARDS的独立危险因素(P < 0.05)。本研究基于此构建的Nomogram模型对于肺部感染肺炎克雷伯杆菌后进展为ARDS的早期诊断、早期干预提供了重要的指导意义。 Objective: To analyze the clinical features of progression to acute respiratory distress syndrome (ARDS) after Carbapenem-resistant Klebsiella pneumoniae (CRKP) lung infection and Nomogram model was constructed. Methods: A total of 162 patients with CRKP isolated from alveolar lavage fluid after all lung infections were retrospectively collected in the Second People’s Hospital of Hefei City from January 2019 to December 2022, of which 71 patients progressed to ARDS after CRKP lung infection, which is the ARDS group, and 91 patients did not progress to ARDS after CRKP lung infection, which is the non-ARDS group. Using SPASS 26.0 software, the clinical data collected from the patients were analyzed by single-factor and logistic multifactorial analysis, and the receiver op-erator characteristic (ROC) curves were analyzed to determine the optimal cut-off value of the risk factors for progression to ARDS after diagnosis of CRKP-resistant lung infections as well as the area under the ROC curve (AUC). The Nomogram model was constructed using the R software “rms” package, the calibration curves were used for internal validation of the Nomogram model, and the decision curve was constructed using the R software “rmda” package, and the predictive efficiency of the Nomogram model was evaluated. And if P 67.5 years), SOFA (>1.5 points), and CCI (>3.5 points) were independent risk factors (P < 0.05) for the development of ARDS after CRKP lung infection. The Nomogram model constructed in this study based on this provides an im-portant guideline for early diagnosis and early intervention for progression to ARDS after pulmo-nary infection with Klebsiella pneumoniae.
出处 《临床医学进展》 2023年第9期14824-14832,共9页 Advances in Clinical Medicine
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