老年急性心衰患者医院获得性肺炎风险预测模型的构建与验证:基于系统免疫炎性指数和预后营养指数

doi:10.3969/j.issn.1003-9198.2026.01.012

摘要/Abstract

摘要： 目的探讨系统免疫炎性指数(SII)和预后营养指数(PNI)对老年心力衰竭(心衰)患者合并医院获得性肺炎(HAP)的预测价值。方法选取2020年3月至2023年3月南京医科大学附属南京医院收治的122例老年急性心衰患者作为训练集,依据是否发生HAP分为感染组(n=54)和未感染组(n=68),采用多因素logistic回归分析筛选HAP的独立危险因素并构建预测模型。另选取2023年4月至2024年3月收治的80例患者作为验证集进行外部验证。采用ROC曲线评估模型的区分度,采用Hosmer-Lemeshow(H-L)拟合优度检验评估校准度,并采用DeLong检验比较模型在训练集与验证集上的一致性。结果感染组年龄、吸烟史、合并症、心功能指标、炎症及营养参数等方面与未感染组差异有统计学意义(均P < 0.05)。多因素logistic回归分析显示,年龄≥66岁、合并糖尿病、侵入性操作、SII≥346、PNI<43是老年急性心衰患者合并HAP的独立危险因素。基于此构建的预测模型在训练集和验证集中的ROC曲线的AUC分别为0.829和0.830;DeLong检验提示两数据集AUC差异无统计学意义(P=0.990);H-L检验显示,预测概率与实际概率拟合良好(P=0.056、0.159)。结论基于SII和PNI构建的预测模型可有效评估老年急性心衰患者发生HAP的风险,具有良好的临床适用性与泛化能力,可作为辅助工具,用于早期识别高危人群,优化临床管理。

关键词: 老年人, 心力衰竭, 医院获得性肺炎, 系统免疫炎性指数, 预后营养指数

Abstract: Objective To evaluate the predictive value of the systemic immune-inflammatory index (SII) and prognostic nutritional index (PNI) in identifying hospital-acquired pneumonia (HAP) in elderly patients with acute heart failure (AHF). Methods A total of 122 elderly AHF patients admitted to Nanjing’s Hospital of Nanjing Medical University from March 2020 to March 2023 were enrolled as the training set and were divided into an infected group (n=54) and an uninfected group (n=68) based on whether they had HAP. Logistic regression was used to identify risk factors for HAP and a prediction model was developed. The model was validated in an independent cohort of 80 patients admitted from April 2023 to March 2024. The performance of the model was assessed by the area under the receiver operating characteristic curve (AUC). Calibration and consistency between the training and validation sets were evaluated by Hosmer-Lemeshow and DeLong tests, respectively. Results The infected group and the uninfected group showed significant differences in age, smoking history, comorbidities, cardiac function, and inflammatory/nutritional parameters (all P<0.05). Multivariate logistic regression analysis identified age ≥66 years old, diabetes, invasive procedures, SII≥346, and PNI <43 as independent risk factors for HAP. The model demonstrated strong discrimination power, with an AUC of 0.829 in the training set and 0.830 in the validation set. Delong test revealed no significant difference in AUC between the two sets (P=0.990). Good calibration was confirmed by Hosmer-Lemeshow test (P=0.056, 0.159). Conclusions The prediction model based on SII and PNI effectively stratifies HAP risk in elderly AHF patients, showing good clinical applicability for early identification of high-risk individuals and optimized management.

Key words: aged, heart failure, hospital-acquired pneumonia, systemic immune inflammatory index, prognostic nutritional index

中图分类号:

沈丽丽, 沈华, 孙才智, 梁钰. 老年急性心衰患者医院获得性肺炎风险预测模型的构建与验证:基于系统免疫炎性指数和预后营养指数[J]. 实用老年医学, 2026, 40(1): 57-61.

SHEN Lili, SHEN Hua, SUN Caizhi, LIANG Yu. Construction and validation of a prediction model for hospital-acquired pneumonia in elderly patients with acute heart failure based on systemic immune inflammatory index and prognostic nutritional index[J]. Practical Geriatrics, 2026, 40(1): 57-61.

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