Research Institute of the Hospital for Sick Children, Toronto, Ontario, Canada.
Clin Infect Dis. 2010 Feb 15;50(4):493-501. doi: 10.1086/649925.
Nosocomial pneumonia is an important cause of morbidity and mortality among surgical patients in the United States. The emergence of effective but potentially costly or risky preventive interventions makes perioperative risk stratification desirable. We sought to develop a prediction rule for pneumonia after coronary artery bypass grafting (CABG), a common surgical procedure.
Data on individuals undergoing CABG at 32 hospitals in 6 states were extracted from Tenet Healthcare's Quality and Resource Management System. A logistic regression-based prediction rule was developed in half of the study sample and validated in the remaining patients.
Of 17,143 individuals undergoing CABG from January 1999 through February 2004, 361 (2%) developed pneumonia without a known aspiration etiology. Thirteen independent predictors of pneumonia were identified in the derivation subset of the sample: body mass index <18.5 (defined as the weight in kilograms divided by the square of the height in meters), smoking history, admission from a nonresidential setting, cancer history, chronic obstructive pulmonary disease, Canadian Cardiovascular Society score 3, prior internal mammary artery CABG, emergency status, serum creatinine level >1.2 mg/dL, percutaneous transluminal coronary angioplasty, blood transfusion, preoperative vancomycin administration, and receipt of mechanical ventilation for >1 day. The model-based rule was well calibrated (Hosmer-Lemeshow X(2)=5.51; P=.70) and demonstrated good discrimination (area under the receiver-operating characteristic curve [ROC AUC], 0.78) in the derivation group. Discriminatory ability was also reasonable in the validation cohort (ROC AUC, 0.75; P=.18, for difference in ROC AUC between groups).
Using a large cohort of patients treated at community and teaching hospitals, we derived and validated a prediction rule for pneumonia after CABG. This index may prove to be useful in prioritizing receipt of preventive interventions.
医院获得性肺炎是美国外科患者发病率和死亡率的重要原因。有效的预防干预措施的出现，但可能成本高昂或存在风险，这使得围手术期风险分层成为理想选择。我们试图为冠状动脉旁路移植术（CABG）后肺炎开发一种预测规则，这是一种常见的手术。
从 6 个州的 32 家医院的 Tenet Healthcare 的质量和资源管理系统中提取了 32 家医院进行 CABG 的个人数据。在研究样本的一半中开发了基于逻辑回归的预测规则，并在其余患者中进行了验证。
在 1999 年 1 月至 2004 年 2 月期间接受 CABG 的 17143 人中，有 361 人（2%）患有肺炎，且病因未知。在样本的推导部分中确定了肺炎的 13 个独立预测因素：体重指数<18.5（定义为体重除以身高的平方）、吸烟史、非居住环境入院、癌症史、慢性阻塞性肺疾病、加拿大心血管学会评分 3 分、以前的内乳动脉 CABG、紧急状态、血清肌酐水平>1.2mg/dL、经皮腔内冠状动脉成形术、输血、术前万古霉素给药以及机械通气>1 天。基于模型的规则具有良好的校准（Hosmer-Lemeshow X(2)=5.51；P=.70），在推导组中具有良好的区分能力（接收者操作特征曲线下面积[ROC AUC]，0.78）。该验证队列中的区分能力也合理（ROC AUC，0.75；P=.18，组间 ROC AUC 的差异）。
使用来自社区和教学医院的大量患者队列，我们为 CABG 后肺炎开发并验证了一种预测规则。该指数可能有助于确定预防干预措施的优先级。
