Lang Qin, Li Lijuan, Zhang Yue, He Xing, Liu Yafeng, Liu Zhen, Yan Haiying
Department of Pulmonary and Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610000, People's Republic of China.
Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610000, People's Republic of China.
Infect Drug Resist. 2023 Feb 4;16:755-767. doi: 10.2147/IDR.S398850. eCollection 2023.
pneumonia (PJP) is an opportunistic but potentially fatal infection with increasing prevalence in HIV-free patients. Glucocorticoid therapy is one of the most important risk factors for PJP. The delay in diagnosis contributes to poor outcomes. Hence, the aim of this study was to develop and validate a nomogram for the diagnosis of PJP in patients with non-HIV-infected pneumonia who are undergoing oral glucocorticoid treatment.
This study was a retrospective, cross-sectional research. The development group included 434 patients who were admitted with pneumonia from 6 hospitals. Demographics, symptomatic features, laboratory and computed tomography data were analyzed using the least absolute shrinkage and selection operator (LASSO) to select potential diagnostic indicators. Binary logistic regression was used to develop a diagnostic nomogram. Another 119 patients with pneumonia admitted at Sichuan Provincial People's Hospital was used as the validation group. The diagnostic performance of the nomogram was measured by area under the receiver-operating-characteristics curve (AUC), calibration curves, and the net benefit by decision curve.
PJP prevalence was 25.3% in the development group. LASSO regression revealed that age, lymphocyte count, fever, dry cough, respiratory failure, ground-glass opacity in lungs, glucocorticoid therapy duration, and immunosuppressive therapy were indicators of PJP. The nomogram showed robust discrimination, with an AUC of 0.82 (95% CI 0.77-0.86) in the development group and an AUC of 0.87 (95% CI 0.80-0.94) in the validation group, both showing acceptable calibration. In the decision curve analysis, our model consistently achieved a greater net benefit across almost all ranges of clinical thresholds.
We developed a nomogram with good diagnostic power for PJP diagnosis in pneumonia patients receiving oral glucocorticoids. This nomogram may help promote timely treatment of PJP and thus reduce the mortality rate in these patients.
肺孢子菌肺炎（PJP）是一种机会性感染，但可能致命，在未感染HIV的患者中患病率呈上升趋势。糖皮质激素治疗是PJP最重要的危险因素之一。诊断延迟会导致不良后果。因此，本研究的目的是开发并验证一种列线图，用于诊断正在接受口服糖皮质激素治疗的非HIV感染肺炎患者的PJP。
本研究为回顾性横断面研究。开发组包括来自6家医院的434例因肺炎入院的患者。使用最小绝对收缩和选择算子（LASSO）分析人口统计学、症状特征、实验室及计算机断层扫描数据，以选择潜在的诊断指标。采用二元逻辑回归建立诊断列线图。另将四川省人民医院收治的119例肺炎患者作为验证组。通过受试者操作特征曲线（AUC）下面积、校准曲线及决策曲线净效益来衡量列线图的诊断性能。
开发组中PJP患病率为25.3%。LASSO回归显示，年龄、淋巴细胞计数、发热、干咳、呼吸衰竭、肺部磨玻璃影、糖皮质激素治疗持续时间及免疫抑制治疗是PJP的指标。列线图显示出强大的辨别能力，开发组的AUC为0.82（95%CI 0.77 - 0.86），验证组的AUC为0.87（95%CI 0.80 - 0.94），两者校准均可接受。在决策曲线分析中，我们的模型在几乎所有临床阈值范围内均始终实现更大的净效益。
我们开发了一种对接受口服糖皮质激素治疗的肺炎患者诊断PJP具有良好诊断能力的列线图。该列线图可能有助于促进PJP的及时治疗，从而降低这些患者的死亡率。
