背景:高毒力肺炎克雷伯菌(hvKP)正在全球范围内出现,可引起多种,健康个体的严重感染。然而,hvKP感染的临床表现是非特异性的,并且没有区分hvKP菌株的黄金标准。我们的目标是开发预后模型,以评估hvKP感染患者的疾病严重程度并预测30天全因死亡率。
方法:我们招募了116例诊断为hvKP感染的患者,并获得了他们的人口统计学和临床数据。以脓毒性休克和急性呼吸窘迫综合征(ARDS)作为疾病严重程度的主要结果,以30天全因死亡率作为临床预后的主要结果,探讨其影响因素并构建预后模型。
结果:结果显示,急性生理和慢性健康评估(APACHE)II评分[比值比(OR)=1.146;95%置信区间(CI),1.059-1.240],白蛋白(ALB)水平降低(OR=0.867;95%CI,0.758-0.990),糖尿病(OR=9.591;95%CI,1.766-52.075)和降钙素原(PCT)水平高(OR=1.051;95CI,1.005-1.099)是感染性休克的独立危险因素。APACHEII评分增加(OR=1.254;95%CI,1.110-1.147),社区获得性肺炎(CAP)(OR=11.880;95%CI,2.524-55.923),和肝外病变(OR=14.718;95%CI,1.005-215.502)是ARDS的独立危险因素。用这些独立的危险因素构建疾病严重程度的预后模型,模型与连续性肾脏替代治疗(CRRT)持续时间显著相关,血管升压药持续时间,机械呼吸机持续时间和ICU住院时间。我们研究的30天全因死亡率为28.4%。年龄较小[危险比(HR)=0.947;95%CI,0.923-0.973],APACHEII评分增加(HR=1.157;95%CI,1.110-1.207),ALB水平下降(HR=0.924;95%CI,0.869-0.983)是30天全因死亡率的独立危险因素。建立了30天死亡率的预测模型,具有良好的验证效果。
结论:我们开发了包含常规临床参数的验证模型,用于评估hvKP感染患者的疾病严重程度和预测30天死亡率,并证实了其校准。这些模型可以帮助临床医生评估疾病严重程度和早期估计30天死亡率。
BACKGROUND: Hypervirulent Klebsiella pneumoniae (hvKP) is emerging globally and can cause various, severe infections in healthy individuals. However, the clinical manifestations of hvKP infections are nonspecific, and there is no gold standard for differentiating hvKP strains. Our objective was to develop prognostic models for estimating severity of disease and predicting 30-day all-cause mortality in patients with hvKP infections.
METHODS: We enrolled 116 patients diagnosed with hvKP infections and obtained their demographic and clinical data. Taking septic shock and acute respiratory distress syndrome (ARDS) as the primary outcomes for disease severity and 30-day all-cause mortality as the primary outcome for clinical prognosis, we explored the influencing factors and constructed prognostic models.
RESULTS: The results showed that increased Acute Physiologic and Chronic Health Evaluation (APACHE) II score [odds ratio (OR) = 1.146; 95% confidence interval (CI), 1.059-1.240], decreased albumin (ALB) level (OR = 0.867; 95% CI, 0.758-0.990), diabetes (OR = 9.591; 95% CI, 1.766-52.075) and high procalcitonin (PCT) level (OR = 1.051; 95%CI, 1.005-1.099) were independent risk factors for septic shock. And increased APACHE II score (OR = 1.254; 95% CI, 1.110-1.147), community-acquired pneumonia (CAP) (OR = 11.880; 95% CI, 2.524-55.923), and extrahepatic lesion involved (OR = 14.718; 95% CI, 1.005-215.502) were independent risk factors for ARDS. Prognostic models were constructed for disease severity with these independent risk factors, and the models were significantly correlated with continuous renal replacement therapy (CRRT) duration, vasopressor duration, mechanical ventilator duration and length of ICU stay. The 30-day all-cause mortality rate in our
study was 28.4%. Younger age [hazard ratio (HR) = 0.947; 95% CI, 0.923-0.973)], increased APACHE II score (HR = 1.157; 95% CI, 1.110-1.207), and decreased ALB level (HR = 0.924; 95% CI, 0.869-0.983) were the independent risk factors for 30-day all-cause mortality. A prediction model for 30-day mortality was constructed, which had a good validation effect.
CONCLUSIONS: We developed validated models containing routine clinical parameters for estimating disease severity and predicting 30-day mortality in patients with hvKP infections and confirmed their calibration. The models may assist clinicians in assessing disease severity and estimating the 30-day mortality early.