Clinical profile analysis and nomogram for predicting in-hospital mortality among elderly severe community-acquired pneumonia patients: a retrospective cohort study

• Published in: BMC pulmonary medicine 2024-01, Vol.24 (1), p.38-38, Article 38
• Main Authors: Wei, Chang, Wang, Xinyu, He, Dingxiu, Huang, Dong, Zhao, Yue'an, Wang, Xinyuan, Liang, Zong'an, Gong, Linjing
• Format: Article
• Language: English
• Subjects: Aged patients; Analysis; Blood; Care and treatment; Cohort analysis; Community-acquired infections; Comorbidity; Development and progression; Diabetes; Hospitals; In-hospital mortality; Infections; Infectious diseases; Kidney diseases; Leukocytes (neutrophilic); Long term health care; Medical prognosis; Medical records; Mortality; Nomogram; Nomograms; Nomography (Mathematics); Nursing homes; Older people; Patients; Platelets; Pneumonia; Prediction models; Regression analysis; Respiratory failure; Risk factors; Sepsis; Severe community-acquired pneumonia (SCAP); The elderly; Variables; Vital signs
• ISSN: 1471-2466; 1471-2466
• DOI: 10.1186/s12890-024-02852-x

Severe community-acquired pneumonia is one of the most lethal forms of CAP with high mortality. For rapid and accurate decisions, we developed a mortality prediction model specifically tailored for elderly SCAP patients. The retrospective study included 2365 elderly patients. To construct and validate the nomogram, we randomly divided the patients into training and testing cohorts in a 70% versus 30% ratio. The primary outcome was in-hospital mortality. Univariate and multivariate logistic regression analyses were used in the training cohort to identify independent risk factors. The robustness of this model was assessed using the C index, ROC and AUC. DCA was employed to evaluate the predictive accuracy of the model. Six factors were used as independent risk factors for in-hospital mortality to construct the prediction model, including age, the use of vasopressor, chronic renal disease, neutrophil, platelet, and BUN. The C index was 0.743 (95% CI 0.719-0.768) in the training cohort and 0.731 (95% CI 0.694-0.768) in the testing cohort. The ROC curves and AUC for the training cohort and testing cohort (AUC = 0.742 vs. 0.728) indicated a robust discrimination. And the calibration plots showed a consistency between the prediction model probabilities and observed probabilities. Then, the DCA demonstrated great clinical practicality. The nomogram incorporated six risk factors, including age, the use of vasopressor, chronic renal disease, neutrophil, platelet and BUN, which had great predictive accuracy and robustness, while also demonstrating clinical practicality at ICU admission.