老年慢性阻塞性肺疾病急性加重病人呼吸机相关性肺炎诺莫图模型的预测价值

目的 筛选老年慢性阻塞性肺疾病（COPD）急性加重病人发生呼吸机相关性肺炎（VAP）的危险因子，验证以此构建的诺莫图预测模型的价值。方法 以2016年12月至2021年11月聊城市第二人民医院收治的374例老年COPD病人为研究对象，按6∶4的比例，采用随机数字表法分为建模集（n=225）与验证集（n=149）。分析VAP的影响因素，建立诺莫图模型并评估其预测价值。结果 VAP组病人年龄[（70.56±6.33）岁比（68.01±6.06）岁]、急性生理和慢性健康（APACHEⅡ）评分[（20.44±6.89）分比（12.20±4.60）分]、序贯器官衰竭（SOFA）评分[（7.65±3.32）分比4.12±1.82）分]、有吸烟史比例（71.9%比54.8%）、合并基础疾病≥3种比例（45.6%比18.5%）、过去90 d使用抗生素比例（63.2%比40.5%）、呼吸机通气时长≥4 d比例（77.2%比40.5%）、再次插管比例（80.7%比46.4%）较非VAP组升高（P<0.05）。logistic回归分析结果示，合并基础疾病≥3种（OR=2.78,P=0.027）、APA...

Predictive value of the nomogram model for ventilator-associated pneumonia in elderly patients with acute exacerbation of chronic obstructive pulmonary disease

Objective To screen the risk factors for ventilator-associated pneumonia (VAP) in elderly patients with acute exacerba-tion of chronic obstructive pulmonary disease (COPD), and to verify the value of the nomogram prediction model constructed in this way.Methods A total of 374 elderly COPD patients who were admitted to the Liaocheng Second People''s Hospital from December 2016 toNovember 2021 were included in the study, and the subjects were divided into a modeling set (n=225) and a validation set (n=149) at aratio of 6:4 and by using the random number table method. The influencing factors of VAP were analyzed, a nomogram model was estab-lished and its predictive value was evaluated. Results The age of patients in the VAP group [(70.56±6.33) years vs. (68.01±6.06) years], Acute Physiology and Chronic Health (APACHEⅡ) score [(20.44±6.89) points vs. (12.20±4.60) points], Sequential Organ Fail- ure (SOFA) score [(7.65±3.32) points vs. (4.12±1.82) points], proportion with history of smoking (71.9% vs. 54.8%), proportion with ≥ 3 comorbid underlying diseases (45.6% vs. 18.5%), proportion with antibiotics in the past 90 d (63.2% vs. 40.5%), proportion with ≥ 4 d of ventilatory ventilation (77.2% vs. 40.5%), and proportion with reintubation (80.7% vs. 46.4%) were elevated compared with those in the non-VAP group (P<0.05). Logistic regression analysis showed that combined underlying diseases ≥ 3 (OR=2.78, P=0.027), APACHEⅡ score (OR=9.46, P<0.001), SOFA score (OR=2.98, P=0.010), use of antibiotics in the past 90 days (OR=2.71, P=0.015), ventilator ventilation duration ≥ 4 days (OR=3.23, P=0.006), and reintubation (OR=3.65, P=0.004) were independent risk factors forVAP. The calibration curve results of both the modeling set and the validation set showed that the constructed nomogram predictionmodel had good calibration, and the areas under the ROC curve were 0.87 [95%CI: (0.82,0.93)] and 0.83 [95%CI:(0.75,0.92)], respec- tively.Conclusion The nomogram model established by risk factors including combined underlying diseases ≥ 3, APACHEⅡ score,SOFA score, antibiotic use in the past 90 days, ventilator ventilation duration ≥ 4 days and reintubation has a good predictive value forthe occurrence of VAP in elderly patients with acute exacerbation of COPD.Key words:Pulmonary disease, chronic obstructive; Pneumonia, ventilator-associated; Antibacterial agents; Risk factors; No-the non-VAP group (P<0.05). Logistic regression analysis showed that combined underlying diseases ≥ 3 (OR=2.78, P=0.027), APACHEⅡ score (OR=9.46, P<0.001), SOFA score (OR=2.98, P=0.010), use of antibiotics in the past 90 days (OR=2.71, P=0.015), ventilator ventilation duration ≥ 4 days (OR=3.23, P=0.006), and reintubation (OR=3.65, P=0.004) were independent risk factors forVAP. The calibration curve results of both the modeling set and the validation set showed that the constructed nomogram predictionmodel had good calibration, and the areas under the ROC curve were 0.87 [95%CI: (0.82,0.93)] and 0.83 [95%CI:(0.75,0.92)], respec- tively.Conclusion The nomogram model established by risk factors including combined underlying diseases ≥ 3, APACHEⅡ score,SOFA score, antibiotic use in the past 90 days, ventilator ventilation duration ≥ 4 days and reintubation has a good predictive value forthe occurrence of VAP in elderly patients with acute exacerbation of COPD.