| Objectives The aim of this study is to investigate the relationship between neutrophil-to-albumin ratio(NAR),lactate(Lac),and mean platelet volume(MPV)and the prognosis of patients with community-acquired pneumonia(CAP).To further explore the effect of these three indexes combined with CURB-65 score in predicting the prognosis of CAP.To provide a simple predictive tool for CAP,attract the attention of doctors in advance and take intervention measures as early as possible.Methods According to the inclusion and exclusion criteria,381 patients with community-acquired pneumonia admitted to the Department of Respiratory Medicine and Critical Care Medicine of the Affiliated Hospital of North China University of Science and Technology from January 2019 to December 2021 were selected as the study subjects.The patients were divided into survival group(n=333)and death group(n=48)according to the prognosis within 30 days after admission.Based on univariate analysis and Logistic analysis,prognostic factors were identified in CAP patients.Based on this,a CAP prognostic nomogram prediction model was constructed:then H-L fitting curve was drawn to assess the effectiveness of the model,and the sensitivity,specificity and diagnostic coincidence rate were obtained from the receiver operating characteristic(ROC)curve to evaluate the accuracy and authenticity of the nomogram prediction model,and then the clinical application value of the nomogram prediction model was evaluated.Results 1 Univariate analysis:Comparison of age,CURB-65 score,diabetes,coronary heart disease,kidney disease,respiratory rate,white blood cells,total protein,NAR,MPV,urea nitrogen,D-dimer,lactate,and multilobar infiltration between the dead survival groups revealed statistically significant differences(P<0.05),indicating that the above factors can increase the risk of prognostic death in CAP patients.There was no significant difference in gender,smoking history,hypertension,hyperlipidemia,shivering,chest pain,hemoptysis,shortness of breath,body temperature,pulse,systolic blood pressure,lymphocyte count,hypersensitive C-reactive protein,fibrinogen,creatinine,ALT,AST and pulmonary nodules between the two groups(P>0.05)2 Multivariate analysis:Multivariate logistic regression analysis was performed with the above 16 statistically significant indicators as independent variables and whether the prognosis of CAP patients survived as the dependent variable.The results suggested that CURB-65 score,NAR,MPV,lactate,and multilobar invasion were independent risk factors for the prognosis of CAP patients(P<0.05).3 CURB-65 score,NAR,MPV,and lactate were maximally integrated using R software to draw a nomogram model for predicting the prognosis of CAP patients.4 Evaluation of nomogram prediction model:H-L fitting degree curve was used to assess the effectiveness of nomogram prediction model,and the result?~2=5.010,P=0.756 was obtained,suggesting that the model had good prediction effectiveness;the area under ROC curve was 0.957,the sensitivity and specificity were 95.8%and 82.9%,respectively,and kappa value of the prediction model were was 0.528,suggesting that the model had good accuracy and prediction value.Conclusions Based on CURB-65 score,NAR,MPV and Lac,the nomogram model established to predict the prognostic risk of CAP patients has good accuracy and clinical application value,which has guiding significance for the identification of patients and clinical intervention decisions in these patients.Figure 4;Table 11;Reference 256... |
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