Development and Validation of a Nomogram for Predicting 28-Day Mortality on Admission in Elderly Patients with Severe Community-Acquired Pneumonia

Abstract

Yansha Song,1,* Xiaocen Wang,1,* Ke Lang,1,* Tingting Wei,1 Jinlong Luo,1 Yuanlin Song,1,2 Dong Yang1,2 1Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 2Shanghai Key Laboratory of Lung Inflammation and Injury, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Dong Yang; Yuanlin Song, Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, People’s Republic of China, Tel [phone], Email [email protected]; [email protected]: There were few studies on the mortality of severe community-acquired pneumonia (SCAP) in elderly people. Early prediction of 28-day mortality of hospitalized patients will help in the clinical management of elderly patients (age ≥ 65 years) with SCAP, but a prediction model that is reliable and valid is still lacking.Methods: The 292 elderly patients with SCAP met the criteria defined by the American Thoracic Society from 33 hospitals in China. Clinical parameters were analyzed by the use of univariable and multivariable logistic regression analysis. A nomogram to predict the 28-day mortality in elderly patients with SCAP was constructed and evaluated using the area under the receiver operating characteristic curve (AUC) and internally verified using the Bootstrap method.Results: A total of 292 elderly patients (227 surviving and 65 died within 28 days) were included in the analysis. Age, Glasgow score, blood platelet, and blood urea nitrogen values were found to be significantly associated with 28-day mortality in elderly patients with SCAP. The AUC of the nomogram was 0.713 and the calibration curve for 28-day mortality also showed high coherence between the predicted and actual probability of mortality.Conclusion: This study provides a nomogram containing age, Glasgow score, blood platelet, and blood urea nitrogen values that can be conveniently used to predict 28-day mortality in elderly patients with SCAP. This model has the potential to assist clinicians in evaluating prognosis of patients with SCAP.Keywords: severe community-acquired pneumonia, 28-day mortality prediction model, nomogram

Keywords

• severe community-acquired pneumonia
• 28-day mortality prediction model
• nomogram