老年2型糖尿病并发重症肺炎病人院内死亡的危险因素分析

doi:10.3969/j.issn.1003-9198.2025.05.016

摘要/Abstract

摘要： 目的探讨老年T2DM并发重症肺炎(SP)病人院内死亡的影响因素,并构建预测模型。方法本研究为回顾观察性研究,选择2019年5月至2024年5月海军军医大学第二附属医院ICU收治的208例老年T2DM并发SP病人,根据病人住院28 d院内存活情况分为死亡组与存活组。采用多因素logistic回归确定老年T2DM并发SP病人院内死亡的危险因素并构建预测模型,采用ROC曲线评估预测模型对老年T2DM并发SP病人预后不良的预测效能,Hosmer-Lemeshow(H-L)检验评估预测模型的校准度。结果 208例病人住院28 d死亡85例(40.87%)。T2DM相关并发症数量≥2个、高中性粒细胞与淋巴细胞比值(NLR)、高BNP、高血乳酸、低氧合指数是老年T2DM并发SP病人院内死亡的独立危险因素。根据上述5个危险因素构建的预测模型预测老年T2DM并发SP病人院内死亡的AUC为0.862,灵敏度、特异度分别为87.06%、83.74%。H-L检验P=0.112。结论 T2DM相关并发症数量、氧合指数、NLR、BNP、血乳酸是影响老年T2DM并发SP病人院内死亡的相关因素,基于以上因素构建的老年T2DM并发SP病人院内死亡预测模型具有较高预测价值。

关键词: 2型糖尿病, 重症肺炎, 预后, 院内死亡, 预测模型

Abstract: Objective To investigate the influencing factors of in-hospital death in the elderly patients with type 2 diabetes mellitus (T2DM) complicated with severe pneumonia (SP), and to establish a prediction model. Methods A retrospective observational study was conducted on 208 elderly patients with T2DM complicated with SP admitted to Intensive Care Unit of the Second Affiliated Hospital of Naval Medical University from May 2019 to May 2024. The patients were divided into death group and surviving group based on the 28-day survival status during hospitalization. Multivariate logistic regression analysis was used to determine the risk factors for in-hospital death in the elderly patients with T2DM complicated with SP and to construct a prediction model. Receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of the model, and Hosmer-Lemeshow (H-L) test was used to evaluate the calibration of the model. Results Among 208 patients, 85 cases died within 28 days of admission (40.87%). The number of T2DM-related complications≥2, high levels of neutrophil-to-lymphocyte ratio (NLR), brain natriuretic peptide (BNP), blood lactic acid,and low level of partial pressure of oxygen (PaO₂)/fraction of inspired oxygen (FiO₂) ratio were the independent risk factors for in-hospital death in elderly patients with T2DM complicated with SP. The area under the curve of the prediction model constructed based on the five risk factors was 0.862, and the sensitivity and specificity were 87.06% and 83.74%, respectively. H-L test showed P=0.112. Conclusions The number of T2DM-related complications, PaO₂/FiO₂ ratio, NLR, BNP and blood lactic acid are influencing factors for in-hospital death in the elderly patients with T2DM complicated with SP. The in-hospital death prediction model for elderly patients with T2DM complicated with SP based on these factors has a high predictive value.

Key words: type 2 diabetes mellitus, severe pneumonia, prognosis, death in hospital, prediction model

中图分类号:

陈立娟, 董丹, 刘怡琳, 张易, 俞荷花. 老年2型糖尿病并发重症肺炎病人院内死亡的危险因素分析[J]. 实用老年医学, 2025, 39(5): 514-518.

CHEN Lijuan, DONG Dan, LIU Yilin, ZHANG Yi, YU Hehua. Analysis of risk factors for in-hospital death in elderly patients with type 2 diabetes mellitus complicated with severe pneumonia[J]. Practical Geriatrics, 2025, 39(5): 514-518.

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