Development and validation of a nomogram for predicting necrotizing pneumonia in children with refractory Mycoplasma pneumoniae pneumonia.

IF 3.2 3区 医学 Q1 PEDIATRICS
Xiaoying Li, Lihua Zhao, Xiaojian Cui, Yongsheng Xu, Tongqiang Zhang, Wei Guo, Jing Ning
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引用次数: 0

Abstract

Background: The early prediction of pulmonary necrosis in children with severe pneumonia improves patient prognosis and prevents complications. The aim of this study was to establish a linear model for predicting necrotizing pneumonia (NP) caused by Mycoplasma pneumoniae (MP) infection and to investigate the risk factors for lung necrosis in children with refractory Mycoplasma pneumoniae pneumonia (RMPP).

Methods: A total of 536 children with RMPP were enrolled, including 95 with NP and 441 with nonnecrotizing pneumonia (NNP). A prediction model was built on 375 cases and validated on 161 cases, which were divided by random sampling in R software. Multivariate logistic regression was performed to determine optimal predictors and to establish a nomogram for predicting NP. The performance of the nomogram was evaluated by the area under the characteristic curve (AUC), calibration ability and decision curve analysis (DCA).

Results: There were 315 (84.0%) NNP patients and 60 (16.0%) NP patients in the training group (n = 375) and 126 (78.3%) NNP patients and 35 NP patients (21.7%) in the validation group (n = 161). Multivariate logistic regression analysis identified 4 independent predictors that were used to construct a nomogram for predicting NP in children with RMPP, namely, fever duration (AOR = 1.475; 95% CI 1.296-1.678; P < 0.001), WBC count (AOR = 1.149; 95% CI 1.073-1.231; P < 0.001), IL-6 concentration (AOR = 1.007; 95% CI 1.002-1.013; P = 0.007) and D-dimer concentration (AOR = 1.361; 95% CI 1.121-1.652; P = 0.002). The area under the curve (AUC) of the nomogram was 0.899 (95% CI, 0.850-0.947) in the training set and 0.920 (95% CI, 0.874-0.966) in the validation set, indicating a good fit. The calibration plot and Hosmer‒Lemeshow test indicated that the predicted probability had good consistency with the actual probability in the training (P = 0.439) and validation (P = 0.526) groups. The DCA curve demonstrated a significantly better net fit in the model.

Conclusions: We developed and validated a nomogram model for predicting RMPP-associated NP in its early clinical stages based on fever duration, WBC count, IL-6 and D-dimer concentration. This four-risk factor model may assist physicians in predicting NP induced by RMPP.

难治性肺炎支原体肺炎患儿坏死性肺炎的nomogram预测方法的开发与验证。
背景:早期预测重症肺炎患儿肺坏死可改善患者预后,防止并发症的发生。本研究旨在建立预测肺炎支原体(Mycoplasma pneumoniae, MP)感染所致坏死性肺炎(necrotizing pneumonia, NP)的线性模型,探讨难治性肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia, RMPP)患儿肺坏死的危险因素。方法:共纳入536例RMPP患儿,其中NP 95例,非坏死性肺炎(NNP) 441例。建立了375例预测模型,并在R软件中随机抽样对161例进行了验证。采用多元逻辑回归来确定最佳预测因子,并建立预测NP的nomogram。通过特征曲线下面积(AUC)、标定能力和决策曲线分析(DCA)来评价nomogram的性能。结果:训练组NNP患者315例(84.0%),NP患者60例(16.0%);验证组NNP患者126例(78.3%),NP患者35例(21.7%)。多因素logistic回归分析确定了4个独立预测因子,用于构建预测RMPP患儿NP的nomogram,即发热持续时间(AOR = 1.475;95% ci 1.296-1.678;结论:我们开发并验证了基于发热时间、白细胞计数、IL-6和d -二聚体浓度预测早期临床阶段rmpp相关NP的nomogram模型。这种四因素模型可以帮助医生预测RMPP引起的NP。
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来源期刊
CiteScore
6.10
自引率
13.90%
发文量
192
审稿时长
6-12 weeks
期刊介绍: Italian Journal of Pediatrics is an open access peer-reviewed journal that includes all aspects of pediatric medicine. The journal also covers health service and public health research that addresses primary care issues. The journal provides a high-quality forum for pediatricians and other healthcare professionals to report and discuss up-to-the-minute research and expert reviews in the field of pediatric medicine. The journal will continue to develop the range of articles published to enable this invaluable resource to stay at the forefront of the field. Italian Journal of Pediatrics, which commenced in 1975 as Rivista Italiana di Pediatria, provides a high-quality forum for pediatricians and other healthcare professionals to report and discuss up-to-the-minute research and expert reviews in the field of pediatric medicine. The journal will continue to develop the range of articles published to enable this invaluable resource to stay at the forefront of the field.
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