老年重症肺炎合并呼吸衰竭患者预后不良的影响因素及预测模型构建

曲思澄; 鲁美彤; 田媛; 臧红松; 林娜; 张兴

文章摘要

曲思澄,鲁美彤,田媛,等.老年重症肺炎合并呼吸衰竭患者预后不良的影响因素及预测模型构建[J].中国临床保健杂志,2025,28(1):92-97.

老年重症肺炎合并呼吸衰竭患者预后不良的影响因素及预测模型构建

Analysis of influencing factors and construction of prediction model for poor prognosis in elderly patients with severe pneumonia complicated with respiratory failure

投稿时间：2024-10-11

DOI：10.3969/J.issn.1672-6790.2025.01.017

中文关键词: 肺炎呼吸功能不全危险因素预后老年人

英文关键词: Pneumonia Respiratory insufficiency Risk factors Prognosis Aged 〖FL

基金项目:辽宁省科学技术计划项目(20131129)

作者	单位	E-mail
曲思澄	北部战区总医院,干三科,沈阳 110016	awyqq4@163.com
鲁美彤	北部战区总医院,干三科,沈阳 110016
田媛	北部战区总医院,干三科,沈阳 110016
臧红松	北部战区总医院,肾脏内科,沈阳 110016
林娜	北部战区总医院,重症医学科,沈阳 110016
张兴	北部战区总医院,干三科,沈阳 110016

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中文摘要:

目的探讨老年重症肺炎合并呼吸衰竭患者预后不良的影响因素,构建预测患者预后不良的列线图模型。方法选取2021年1月至2024年1月北部战区总医院收治的130例老年重症肺炎合并呼吸衰竭患者为内部验证组,另选取同期收治的65例老年重症肺炎合并呼吸衰竭患者为外部验证组。内、外部验证组患者根据治疗后的死亡情况分为预后良好亚组(治愈)和预后不良亚组(死亡)。内部验证组中预后良好亚组86例,预后不良亚组44例；外部验证组中预后良好亚组43例,预后不良亚组22例。收集并比较内、外部验证组的临床资料,筛选影响老年重症肺炎合并呼吸衰竭患者预后不良的因素,基于影响因素构建列线图模型并在内、外部验证组中验证。结果内、外部验证组的临床资料比较,差异无统计学意义(P>0.05)。预后不良亚组年龄≥70岁、中重度呼吸衰竭、免疫麻痹、急性生理学和慢性健康状况评估Ⅱ(APACHE Ⅱ)评分>25分、血红蛋白≤100 g/L、血小板计数≤150×10⁹/L、2 h血乳酸清除率≤10%、白蛋白<34 g/L患者所占比例均高于预后良好亚组(均P<0.05)。年龄≥70岁、中重度呼吸衰竭、免疫麻痹、APACHE Ⅱ评分>25分是老年重症肺炎合并呼吸衰竭患者预后不良的危险因素(P<0.05)。构建的列线图模型在内、外部验证组中均与理想曲线接近。内部验证组的χ2=6.475,P=0.594,AUC=0.906(95%CI:0.853~0.958)；外部验证组的χ2=7.283,P=0.400,AUC=0.900(95%CI:0.818~0.981)。结论年龄≥70岁、中重度呼吸衰竭、免疫麻痹、APACHE Ⅱ评分>25分是老年重症肺炎合并呼吸衰竭患者预后不良的危险因素；基于危险因素构建的列线图模型可有效预测患者预后不良的发生风险,一致性较好。

英文摘要:

Objective To analyze the influencing factors of poor prognosis in elderly patients with severe pneumonia complicated with respiratory failure,and to construct a column chart model for predicting poor prognosis in patients.Methods From January 2021 to January 2024,130 elderly patients with severe pneumonia and respiratory failure admitted to our hospital were included as the internal validation group,and 65 elderly patients with severe pneumonia and respiratory failure admitted were included as the external validation group.The internal and external validation groups were divided into a good prognosis group (cure or outcome) and a poor prognosis group (death) based on the mortality status after treatment.In the internal validation group,there were 86 cases in the good prognosis group and 44 cases in the poor prognosis group.In the external validation group,there were 43 cases in the good prognosis group and 22 cases in the poor prognosis group.Clinical data from the internal and external validation groups were collected and compared,the factors affecting poor prognosis in elderly patients with severe pneumonia and respiratory failure were screened.Based on the influencing factors,a column chart model was constructed and validated in the internal and external validation groups.Results There was no difference in clinical data between the internal and external validation groups (P>0.05).The proportions of patients aged ≥70 years old,with moderate to severe respiratory failure,immunologic paralysis,APACHE Ⅱ score >25 points,hemoglobin ≤ 100 g/L,platelets ≤ 150×10⁹/L,2 h lactate clearance rate ≤10%,and albumin <34 g/L in the poor prognosis group were higher than those in the good prognosis group (P<0.05).Age ≥70 years old,moderate to severe respiratory failure,immunologic paralysis,and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score>25 points were risk factors for poor prognosis in elderly patients with severe pneumonia complicated with respiratory failure (P<0.05).The constructed column chart model was close to the ideal curve in both the internal and external validation groups,with χ2=6.475,P=0.594,AUC=0.906 (95%CI:0.853-0.958) in the internal validation group;and χ2=7.283,P=0.400,AUC=0.900 (95%CI:0.818-0.981) in the external validation group.Conclusions Age ≥70 years,moderate to severe respiratory failure,immunologic paralysis,and APACHE Ⅱ score>25 are risk factors for poor prognosis in elderly patients with severe pneumonia complicated with respiratory failure.A column chart model based on risk factors can effectively predict the risk of poor prognosis in patients with good consistency.

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