通讯作者: 谷强, guqiang106@sina.com

DOI：10.12201/bmr.202504.00059

Risk factors and risk prediction for the course of lobar pneumonia in children

• 摘要：目的：探究影响儿童大叶性肺炎病程的独立危险因素并构建列线图模型进行风险预测。方法：选取2018年1月至2024年6月石河子大学第一附属医院儿科诊断大叶性肺炎住院患儿552例,根据住院天数分为长病程组(≥10天)160例和短病程组(<10天)392例,对两组患儿的数据进行统计分析构建列线图模型并进行内部验证。结果：(1)BAL是大叶性肺炎患儿住院时长的保护性因素；LDH升高、高热、混合感染、存在肺内并发症是大叶性肺炎患儿住院天数≥10天的独立危险因素。(2)训练集组和测试集组ROC曲线的AUC分别为0.915、0.898；Bootstrap法绘制列线图校准曲线与实际曲线基本吻合；临床决策曲线显示阈值在0.010-0.890时列线图模型可获得临床净收益。结论：病原体混合感染、存在肺内并发症、LDH升高、高热是大叶性肺炎患儿住院天数≥10天的独立危险因素,构建的列线图模型具有良好的区分度、校准度和临床应用价值。

  关键词： 大叶性肺炎; 危险因素; 列线图; 儿童

   

  Abstract: Objective: To identify independent risk factors influencing the disease course of pediatric lobar pneumonia and to develop a nomogram model for risk prediction. Methods: A total of 552 children diagnosed with lobar pneumonia and hospitalized in the Department of Pediatrics at the First Affiliated Hospital of Shihezi University between January 2018 and June 2024 were enrolled. Based on the duration of hospitalization, the patients were divided into a long-course group (≥10 days) 160 case and a short-course group (<10 days) 392 case. Data from both groups were statistically analyzed to construct and internally validate a nomogram prediction model. Results: (1) Bronchoalveolar lavage (BAL) was identified as a protective factor for hospitalization duration, while elevated lactate dehydrogenase (LDH), high fever, mixed infections, and the presence of intrapulmonary complications were independent risk factors for a hospitalization duration ≥10 days. (2) The area under the ROC curve (AUC) was 0.915 for the training set and 0.898 for the test set. The calibration curve of the nomogram, generated via the Bootstrap method, closely aligned with the actual curve. Decision curve analysis demonstrated that the nomogram provided clinical net benefit within a threshold probability range of 0.010–0.890. Conclusion: Mixed pathogen infections, intrapulmonary complications, elevated LDH, and high fever are independent risk factors for prolonged hospitalization (≥10 days) in children with lobar pneumonia. The constructed nomogram model exhibits excellent discriminative ability, calibration, and clinical utility.

  Key words: Lobar pneumonia; Risk factors; Nomogram; Children

  提交时间：2025-04-18

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2025-03-30	bmr.202504.00059V1	下载

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