摘要
Abstract
Objective:To investigate the factors associated with severe tuberculosis and construct a risk prediction model to provide a basis for early prediction of severe tuberculosis.Methods:495 patients with severe tuberculosis in the intensive care unit of Shantou Third People's Hospital,and 493 patients with common tuberculosis hospitalized during the same period were retrospectively selected as the study subjects,and were randomly divided into the model group(n=692)and the validation group(n=296)according to the ratio of 7:3.Factors associated with severe tuberculosis were screened by logistic regression analysis,and a nomogram prediction model was constructed.The area under curve(AUC)of the receiver operating characteristic(ROC)was used to assess the discrimination of the prediction model.Hosmer-Lemeshow test and calibration curve were used to assess the calibration of the prediction model.Results:There were 692 cases in the model group,525 males and 167 females,aged 62(52,69)years.There were 296 cases in the validation group,230 males and 66 females,aged 64(52,71)years.The difference in baseline data between the two groups was not statistically significant(P>0.05).Multivariate logistic regression analysis showed that leukocytes(OR=1.099,95%CI:1.013-1.193),hemoglobin(OR=0.832,95%CI:0.799-0.865),albumin(OR=0.869,95%CI:0.778-0.971),and blood urea nitrogen(OR=1.117.95%CI:1.045-1.194),calcitoninogen(OR=1.846,95%CI:1.326-2.569),blood lactate(OR=1.384,95%CI:1.100-1.742),oxygenation index(OR=0.989,95%CI:0.986-0.993),chronic obstructive pulmonary disease(OR=2.242,95%CI:1.120-4.488),bilateral lung segmental involvement(OR=5.051,95%CI:1.323-19.286),destroyed lungs(OR=6.241,95%CI:1.329-29.305),and cardiac arrhythmia(OR=2.275,95%CI:1.186-4.363)were associated with the severe tuberculosis.The ROC curves showed that the AUC values of this nomogram model for predicting the risk of severe tuberculosis in the model and validation groups were 0.963(95%CI:0.952-0.976)and 0.968(95%CI:0.952-0.984),respectively,which indicated that the model was well discriminated.By Hosmer-Lemeshow test,the Pvalues of the model and validation groups were 0.237 and 0.526(both P values>0.05),and the calibration curves were close to the ideal curves,indicating good agreement with the actual results in the model and validation groups.Conclusion:The constructed prediction model has a good ability to predict the risk of developing severe tuberculosis.关键词
重症结核病/列线图/预测模型Key words
severe tuberculosis/nomogram/predictive model分类
医药卫生
