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探讨重症病毒性肺炎合并急性呼吸窘迫综合征（Acute respiratory distress syndrome, ARDS）预后不良的危险因素分析并构建预测模型。回顾性纳入2022年1月至2025年1月本院收治的108例重症病毒性肺炎合并ARDS患者，按入院28d预后情况分为预后良好组（n=69）和预后不良组（n=39），比较2组的基础资料及实验室指标，采用Logistic回归方程分析危险因素，经回归方程拟合的概率值建立预测模型，绘制ROC曲线分析预测变量准确性，并基于危险因素构建决策树模型。Logistic多因素结果显示：年龄≥65岁、APACHE II评分、SOFA评分、机械通气时间、氧合指数≤100 mmHg、NLR是重症病毒性肺炎合并ARDS预后不良的独立危险因素（P<0.05）;ROC曲线显示：上述因素及联合预测模型对预后不良均有预测价值（P<0.05）；基于上述因素建立的决策树模型，以APACHE II评分为首要分层指标，分类准确率达98.3%。因此，监测上述危险因素并应用联合预测模型，可早期识别高风险患者，指导精准干预，改善重症病毒性肺炎合并ARDS预后。
Abstract：This study aimed to identify risk factors for poor prognosis in patients with severe viral pneumonia complicated by acute respiratory distress syndrome(ARDS) and to construct predictive models. A total of 108 patients admitted to our hospital between January 2022 and January 2025 were retrospectively enrolled. Based on 28-day outcomes, patients were classified into a good prognosis group(n = 69) and a poor prognosis group(n = 39). Baseline characteristics and laboratory parameters were compared between the two groups. Logistic regression analysis was performed to determine independent risk factors, and probability values derived from the regression model were used to establish a predictive model. Receiver operating characteristic(ROC) curves were generated to evaluate predictive accuracy, and a decision tree model was further constructed based on the identified risk factors. Multivariate logistic regression revealed that age ≥65 years, APACHE II score, SOFA score, duration of mechanical ventilation, oxygenation index ≤100 mmHg, and neutrophil-to-lymphocyte ratio(NLR) were independent risk factors for poor prognosis(P < 0.05). ROC curve analysis demonstrated that each of these factors as well as the combined prediction model, had significant prognostic value(P < 0.05). The decision tree model, using APACHE II score as the primary stratification variable, achieved a classification accuracy of 98.3%. These findings suggest that monitoring the identified risk factors and applying the combined predictive model can facilitate early identification of high-risk patients, support targeted intervention and improve outcomes in severe viral pneumonia complicated by ARDS.
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基本信息:
DOI：10.13242/j.cnki.bingduxuebao.250205
中图分类号:R563.8;R563.1
引用信息:
[1]周红群,刘慧,雷贤英,等.重症病毒性肺炎合并ARDS预后不良的危险因素分析及预测模型构建[J].病毒学报,2025,41(06):1796-1804.DOI:10.13242/j.cnki.bingduxuebao.250205.
基金信息:
西南医科大学应用基础研究项目（项目号：2023QN078）,题目：R/I指数在ARDS患者中的临床价值研究~~
2025-06-30
2025
2025-07-24
2025-09-29
2025
1
2025-09-30
2025-09-30
2025-09-30