中国临床医学2025，Vol.32Issue(3)：449-457,9.DOI:10.12025/j.issn.1008-6358.2025.20250102
重症肺炎并发呼吸衰竭预测模型的构建
Construction of a prediction model for severe pneumonia complicate with respiratory failure
摘要
Abstract
Objective To explore predictive factors of severe community-acquired pneumonia(CAP)complicated with respiratory failure(RF)and to develop and internally validate a clinical prediction model.Methods A retrospective study was conducted on 350 patients with severe CAP admitted to Tianyou Hospital Affiliated to Wuhan University of Science and Technology from September 2022 to December 2024.Patients were randomly divided into a training set(n=245)and a validation set(n=105)in a 7∶3 ratio,and further categorized into RF and non-RF groups.LASSO regression was applied to optimize variable selection.Multivariate logistic analysis was used to construct the prediction model,followed by internal validation.Results Univariate regression analysis identified male,hypertension,diabetes,coronary heart disease,age,CURB-65 score,white blood cell count,neutrophil count,C-reactive protein(CRP),serum amyloid A,procalcitonin,and hospital stay as risk factors for RF in severe CAP,while albumin level was a protective factor.LASSO regression selected CURB-65 score,albumin level,and CRP for inclusion in the final model.The area under the receiver operating characteristic curve was 0.903 in the training set and 0.919 in the validation set.Calibration curve analysis demonstrated excellent agreement between predicted and observed probabilities in both sets,and Hosmer-Lemeshow goodness-of-fit tests indicated no significant deviations.Threshold probabilities ranged from 0.01 to 0.99 in both training and validation sets.Conclusions CURB-65 score,albumin level,and CRP are independent predictors of RF in severe CAP.The clinical prediction model based on these factors exhibits strong discrimination,calibration,goodness-of-fit,and clinical utility.关键词
重症肺炎/呼吸衰竭/临床预测模型/内部验证法/LASSO回归Key words
severe pneumonia/respiratory failure/clinical predictive model/internal validation/LASSO regression分类
医药卫生引用本文复制引用
高斯宇,张盛,陈曦,张志霞,杨玉梅..重症肺炎并发呼吸衰竭预测模型的构建[J].中国临床医学,2025,32(3):449-457,9.基金项目
国家卫生健康委员会医疗质量(循证)管理研究项目(YLZLXZ24G021).Supported by Medical Quality(Evidence-Based)Management Research Project of National Health Commission(YLZLXZ24G021). （循证）
