Xu Junnan, Weng Jie, Yang Jingwen, Shi Xuan, Hou Ruonan, Zhou Xiaoming, Zhou Zhiliang, Wang Zhiyi, Chen Chan
Department of Emergency Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China, China.
Department of General Practice, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China, China.
PeerJ. 2021 Mar 9;9:e11016. doi: 10.7717/peerj.11016. eCollection 2021.
Acute respiratory failure (ARF) is a life-threatening complication in elderly patients. We developed a nomogram model to explore the risk factors of prognosis and the short-term mortality in elderly patients with ARF.
A total of 759 patients from MIMIC-III database were categorized into the training set and 673 patients from our hospital were categorized into the validation set. Demographical, laboratory variables, SOFA score and APS-III score were collected within the first 24 h after the ICU admission. A 30-day follow-up was performed for all patients.
Multivariate logistic regression analysis showed that the heart rate, respiratoryrate, systolic pressure, SPO, albumin and 24 h urine output were independent prognostic factors for 30-day mortality in ARF patients. A nomogram was established based on above independent prognostic factors. This nomogram had a C-index of 0.741 (95% CI [0.7058-0.7766]), and the C-index was 0.687 (95% CI [0.6458-0.7272]) in the validation set. The calibration curves both in training and validation set were close to the ideal model. The SOFA had a C-index of 0.653 and the APS-III had a C-index of 0.707 in predicting 30-day mortality.
Our nomogram performed better than APS-III and SOFA scores and should be useful as decision support on the prediction of mortality risk in elderly patients with ARF.
急性呼吸衰竭（ARF）是老年患者危及生命的并发症。我们开发了一种列线图模型，以探讨老年ARF患者预后的危险因素和短期死亡率。
将来自MIMIC-III数据库的759例患者分类为训练集，将我院的673例患者分类为验证集。在入住重症监护病房后的前24小时内收集人口统计学、实验室变量、序贯器官衰竭评估（SOFA）评分和急性生理和慢性健康状况评估III（APS-III）评分。对所有患者进行30天随访。
多因素逻辑回归分析显示，心率、呼吸频率、收缩压、血氧饱和度、白蛋白和24小时尿量是ARF患者30天死亡率的独立预后因素。基于上述独立预后因素建立了列线图。该列线图的C指数为0.741（95%可信区间[0.7058 - 0.7766]），验证集中的C指数为0.687（95%可信区间[0.6458 - 0.7272]）。训练集和验证集的校准曲线均接近理想模型。在预测30天死亡率方面，SOFA的C指数为0.653，APS-III的C指数为0.707。
我们的列线图比APS-III和SOFA评分表现更好，在预测老年ARF患者死亡风险方面应作为决策支持工具。
