接受有创机械通气的重症肺炎患者预后影响因素及临床预测模型构建OA

Objective To explore the risk factors affecting the 28-day prognosis of patients with severe pneumonia undergoing invasive mechanical ventilation,construct a clinical prediction model,and provide objective evidence for early identification of high-risk patients.Methods Clinical data of patients with severe pneumonia undergoing inva-sive mechanical ventilation in the intensive care unit(ICU)of a hospital from January 2022 to December 2023 were collected retrospectively.According to the 28-day prognosis,patients were divided into a death group and a survival group,the baseline clinical characteristics of two groups were compared,independent risk factors were screened with multivariate logistic regression analysis,and the nomogram prediction model was constructed.The discrimi-nability and clinical applicability of the model were assessed through receiver operating characteristic(ROC)curve and decision curve analysis(DCA),and the impact of each variable on patients's survival time was assessed by Cox proportional hazards regression model.Results A total of 418 patients were included in the study,with a 28-day mortality of 12.20%.The proportions of male patients,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,and heart rate in the death group were all higher than those in the survival group(all P<0.05).The oxygenation index(PaO2/FiO2)and its stratified analysis showed that the PaO2/FiO2 in patients in the death group decreased significantly(P<0.05).Multivariate logistic regression analysis showed that male,high APACHE Ⅱ score,and low PaO2/FiO2 were independent risk factors for 28-day mortality in patients with severe pneumonia undergoing invasive mechanical ventilation in the ICU;compared with patients with PaO2/FiO2>300 mmHg,those with PaO2/FiO2 of 101-300 mmHg(OR=2.527,95%CI:1.122-5.689,P=0.025)and≤100 mmHg(OR=5.932,95%CI:2.313-15.214,P<0.001)had significantly increased risk of mortality.The nomogram prediction model constructed based on male,APACHE Ⅱ score,and PaO2/FiO2 demonstrated moderate predictive performance verified by DCA.The area under the ROC curve(AUC)of the combined indica-tors was 0.726(sensitivity 60.8%,specificity 73.0%).Multivariate Cox proportional hazards model further con-firmed that for patients with severe pneumonia undergoing invasive mechanical ventilation,risk for 28-day mortality enhaced obviously in those who were male(HR=2.189,95%CI:1.062-4.512),with APACHE Ⅱ score>22.5 points(HR=1.051,95%CI:1.007-1.096),and with low PaO2/FiO2(overall P=0.001).Conclusion Male,high APACHE Ⅱ score,and low PaO2/FiO2 are indepen-dent risk factors for 28-day mortality in patients with severe pneumonia undergoing invasive mechanical ventilation.The clinical prediction model constructed based on the above factors has discriminative ability and can provide reference for early identification of high-risk patients.