奥米克龙时代老年患者 COVID-19 肺炎早期进展的风险因素分析和提名图

IF 3.6 3区医学 Clinical Interventions in Aging Pub Date : 2024-03-11 DOI:10.2147/cia.s453057

Daoda Qi, Yang Chen, Chengyi Peng, Yuan Wang, Zihao Liang, Jingjing Guo, Yan Gu

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引用次数: 0

摘要

背景和目的：及时识别COVID-19老年患者早期进展的风险因素对后续临床治疗具有重要意义。本研究旨在分析奥米克龙时代感染 COVID-19 的老年患者早期进展的风险因素，并创建一个提名图：方法：回顾性招募2022年12月至2023年2月期间收治的感染COVID-19的272名老年患者。使用逻辑回归和最小绝对收缩与选择算子（LASSO）回归确定风险因素选择。然后创建了一个预测早期进展的提名图，随后通过绘制接收者操作特征曲线（ROC）、校准曲线和决策曲线对提名图进行了内部验证和性能评估：共有 83 名（30.5%）老年患者在入院 3-5 天后接受标准起始治疗，胸部 CT 显示病情出现早期进展。六个独立的预测因素被纳入了预测早期进展的提名图中，包括 CRP > 10 mg/L、IL-6 > 6.6 pg/mL、LDH > 245 U/L、CD4+ T 淋巴细胞计数 <400/μL、日常生活活动（ADL）评分≤40 分，以及迷你营养评估量表-简表（MNA-SF）评分≤7 分。在训练队列和验证队列中，提名图在区分具有风险因素的老年患者方面的曲线下面积（AUC）分别为 0.857（95% CI 0.798，0.916）和 0.774（95% CI 0.667，0.881）。校准曲线和决策曲线分别显示了预测风险和观察风险的高度一致性，以及在预测早期进展方面可接受的净效益：我们创建了一个结合了高度可用的实验室数据和老年综合评估（CGA）结果的提名图，该提名图能有效预测Omicron时代COVID-19老年患者的早期进展。关键词：早期进展；CGA；提名图；COVID-19；Omicron时代

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Risk Factor Analysis and Nomogram for Early Progression of COVID-19 Pneumonia in Older Adult Patients in the Omicron Era

Background and Objective: Timely recognition of risk factors for early progression in older adult patients with COVID-19 is of great significance to the following clinical management. This study aims to analyze the risk factors and create a nomogram for early progression in older adult patients with COVID-19 in the Omicron era.
Methods: A total of 272 older adults infected with COVID-19 admitted from December 2022 to February 2023 were retrospectively recruited. Risk factor selection was determined using the logistic and the least absolute shrinkage and selection operator (LASSO) regression. A nomogram was then created to predict early progression, followed by the internal validation and assessment of its performance through plotting the receiver operating characteristic (ROC), calibration, and decision curves.
Results: A total of 83 (30.5%) older adult patients presented an early progression on chest CT after 3– 5 days of admission under standard initiate therapy. Six independent predictive factors were incorporated into the nomogram to predict the early progression, including CRP > 10 mg/L, IL-6 > 6.6 pg/mL, LDH > 245 U/L, CD4⁺ T-lymphocyte count < 400/μL, the Activities of Daily Living (ADL) score ≤ 40 points, and the Mini Nutritional Assessment Scale-Short Form (MNA-SF) score ≤ 7 points. The area under the curve (AUC) of the nomogram in discriminating older adult patients who had risk factors in the training and validation cohort was 0.857 (95% CI 0.798, 0.916) and 0.774 (95% CI 0.667, 0.881), respectively. The calibration and decision curves demonstrated a high agreement in the predicted and observed risks, and the acceptable net benefit in predicting the early progression, respectively.
Conclusion: We created a nomogram incorporating highly available laboratory data and the Comprehensive Geriatric Assessment (CGA) findings that effectively predict early-stage progression in older adult patients with COVID-19 in the Omicron era.

Keywords: early progression, CGA, nomogram, COVID-19, omicron era

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来源期刊

Clinical Interventions in Aging GERIATRICS & GERONTOLOGY-

CiteScore

6.20

自引率

2.80%

发文量

193

期刊介绍： Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.