Xie Li-Na, Feng Te, Guo Yan-Jun, Zhang Yu-Hui, Li Yuan-Zhe, Zhang Wan-Cun
Department of Respiratory Medicine, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2024 May 15;26(5):486-492. doi: 10.7499/j.issn.1008-8830.2311146.
To study the risk factors for embolism in children with refractory pneumonia (RMPP) and to construct a nomogram model for prediction of embolism.
This retrospective study included 175 children diagnosed with RMPP at Children's Hospital Affiliated toZhengzhou University from January 2019 to October 2023. They were divided into two groups based on the presence of embolism: the embolism group (=62) and the non-embolism group (=113). Multivariate logistic regression analysis was used to screen for risk factors of embolism in children with RMPP, and the R software was applied to construct the nomogram model for prediction of embolism.
Multivariate logistic regression analysis indicated that higher levels of D-dimer, interleukin-6 (IL-6) and neutrophil to lymphocyte ratio (NLR), lung necrosis, and pleural effusion were risk factors for embolism in children with RMPP (<0.05). The area under the curve of the nomogram model for prediction of embolism constructed based on the aforementioned risk factors was 0.912 (95%: 0.871-0.952, <0.05). The Hosmer-Lemeshow goodness-of-fit test showed that the model had a good fit with the actual situation (<0.05). Calibration and decision curve analysis indicated that the model had high predictive efficacy and clinical applicability.
Higher levels of D-dimer, IL-6 and NLR, lung necrosis, and pleural effusion are risk factors for embolism in children with RMPP. The nomogram model based on these risk factors has high clinical value for predicting embolism in children with RMPP.
研究难治性肺炎支原体肺炎（RMPP）患儿发生栓塞的危险因素，并构建预测栓塞的列线图模型。
本回顾性研究纳入了2019年1月至2023年10月在郑州大学附属儿童医院诊断为RMPP的175例患儿。根据是否发生栓塞将其分为两组：栓塞组（n = 62）和非栓塞组（n = 113）。采用多因素logistic回归分析筛选RMPP患儿发生栓塞的危险因素，并应用R软件构建预测栓塞的列线图模型。
多因素logistic回归分析显示，D-二聚体、白细胞介素-6（IL-6）及中性粒细胞与淋巴细胞比值（NLR）水平升高、肺坏死及胸腔积液是RMPP患儿发生栓塞的危险因素（P<0.05）。基于上述危险因素构建的预测栓塞的列线图模型的曲线下面积为0.912（95%CI：0.871 - 0.952，P<0.05）。Hosmer-Lemeshow拟合优度检验显示该模型与实际情况拟合良好（P<0.05）。校准和决策曲线分析表明该模型具有较高的预测效能和临床适用性。
D-二聚体、IL-6及NLR水平升高、肺坏死及胸腔积液是RMPP患儿发生栓塞的危险因素。基于这些危险因素的列线图模型对预测RMPP患儿发生栓塞具有较高的临床价值。
