Establishment of a Predictive Model for Acute Respiratory Distress Syndrome in Patients with Bacterial Pneumonia

Figures & data

Table 1 Baseline Characteristics of Included Patients

Variables	Full Cohort (N = 254)	ARDS (n = 114, 44.88%)	Non-ARDS (n = 140, 55.12%)	P value
Gender (male)	175(68.90%)	83(72.80%)	92(65.71%)	0.225
Age (years)	72.5(65–79)	74.5(69–82)	71(61–77)	<0.001
Underlying lung diseases	113(44.49%)	54(47.37%)	59(42.14%)	0.405
Smoking	121(47.64%)	58(50.88%)	63(45.00%)	0.351
Alcoholism	70(27.56%)	27(23.68%)	43(30.71%)	0.212
Hypertension	105(41.34%)	54(47.37%)	51(36.43%)	0.078
Diabetes	30(11.81%)	21(18.42%)	9(6.43%)	0.003
Coronary heart disease	27(10.63%)	9(7.89%)	18(12.86%)	0.202
Cerebrovascular diseases	20(7.87%)	13(11.40%)	7(5.00%)	0.059
Heart failure	13(5.12%)	9(7.89%)	4(2.86%)	0.070
Hyperlipidemia	29(11.42%)	15(13.16%)	14(10.00%)	0.431
Anemia	136(53.54%)	60(52.63%)	76(54.29%)	0.793
Temperature (°C)	37.3(36.7–38.3)	37.5(36.8–38.4)	37.2(36.7–38.2)	0.422
Heart rate(bpm)	95(84–108)	99(88.75–112)	91.5(81–102)	0.002
SBP (mmHg)	124(111–144)	123(106.75–145)	125(112.75–140)	0.621
DBP (mmHg)	73.07±13.56	72.61±14.58	73.44±12.70	0.625
Lymphocyte(×10^9/L)	0.80(0.5–1.3)	0.6(0.4–0.9)	1(0.625–1.475)	<0.001
Neutrophil(×10^9/L)	7.15(4.78–11.33)	9.45(6.15–12.43)	5.9(4.0–8.9)	<0.001
Platelet(×10^9/L)	187.50(138.5–242.75)	180(124.75–252.25)	192.5(144.25–242.00)	0.380
CRP (mg/L)	41.45(5.48–137.78)	59.1(16.18–148.50)	29.35(3.05–127.13)	0.008
WBC(×10^9/L)	8.75(6.48–12.48)	10.5(7.38–14.20)	7.65(5.60–10.68)	<0.001
Prothrombin time(s)	12.7(11.8–13.83)	12.95(11.80–14.70)	12.6(11.70–13.40)	0.020
D-dimer(mg/L)	0.88(0.5–1.75)	1.33(0.73–2.38)	0.69(0.39–1.24)	<0.001
Albumin/Globulin	1.19 (1.01–1.40)	1.16(0.99–1.44)	1.22 (1.04–1.40)	0.252
ALT(U/L)	17.85(12.60–33.03)	18.1(12.78–35.45)	17.6(12.28–30.60)	0.308
AST(U/L)	21.15(17.80–34.13)	23.5(18.35–39.00)	20.5(17.60–31.45)	0.058
AST/ALT	1.28(0.93–1.65)	1.3(0.96–1.70)	1.26(0.91–1.58)	0.187
Creatinine(μmol/L)	68.40(57.55–87.00)	71.85(60.15–114.70)	65.75(55.90–76.50)	0.002
LDH(U/L)	219.25(176.88–274.20)	239.4(190.70–322.90)	197.5(165.75–239.43)	<0.001
Homocysteine(μmol/L)	11.70(8.90–17.13)	13.15(9.25–20.43)	10.7(8.63–14.50)	0.008
Albumin(g/L)	32.28±4.68	30.78±4.47	33.51±4.49	<0.001
Bilateral lung lesions	229(90.16%)	112(98.25%)	117(83.57%)	<0.001
Pleural effusion	130(51.18%)	78(68.42%)	52(37.14%)	<0.001
Pericardial effusion	37(14.57%)	25(21.93%)	12(8.57%)	0.003

Notes: Continuous variables were presented as mean± standard deviation or median (interquartile range), and categorical variables as number (percentage). The statistically significant P values are in bold.

Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; CRP, C-reactive protein; DBP, diastolic blood pressure; LDH, lactate dehydrogenase; SBP, systolic blood pressure; WBC, white blood cell.

Table 2 Univariate and Multivariate Logistic Regression Analyses of Risk Factors for ARDS in Patients with Bacterial Pneumonia

Variables	Univariate Analysis			Multivariate Analysis
	OR	95% CI	P value	OR	95% CI	P value
Gender (male)	0.716	0.417–1.229	0.225
Age (years)	1.044	1.020–1.068	<0.001	1.041	1.014–1.069	0.003
Underlying lung diseases	1.236	0.751–2.032	0.405
Smoking	1.266	0.771–2.078	0.351
Alcoholism	0.700	0.399–1.228	0.213
Hypertension	1.627	0.983–2.691	0.058
Diabetes	3.287	1.441–7.499	0.005
Coronary heart disease	1.248	0.478–3.255	0.651
Cerebrovascular diseases	2.446	0.941–6.352	0.066
Heart failure	2.914	0.873–9.724	0.082
Hyperlipidemia	1.364	0.629–2.958	0.432
Anemia	0.936	0.570–1.536	0.793
Temperature (°C)	1.062	0.836–1.348	0.624
Heart rate(bpm)	1.021	1.007–1.036	0.004	1.020	1.002–1.038	0.028
SBP (mmHg)	0.999	0.990–1.009	0.913
DBP (mmHg)	0.995	0.977–1.014	0.624
Lymphocyte (×10^9/L)	0.333	0.203–0.549	<0.001	0.555	0.324–0.953	0.033
Neutrophil(×10^9/L)	1.062	1.013–1.114	0.013
Platelet(×10^9/L)	0.999	0.996–1.002	0.612
CRP (mg/L)	1.004	1.000–1.007	0.026
WBC (×10^9/L)	1.080	1.027–1.135	0.003	1.062	1.005–1.123	0.033
Prothrombin time (s)	1.222	1.061–1.408	0.005	1.136	0.980–1.317	0.091
D-dimer (mg/L)	1.057	0.997–1.143	0.166
Albumin/Globulin	0.665	0.293–1.510	0.329
ALT (U/L)	1.004	1.000–1.008	0.046
AST (U/L)	1.001	0.999–1.004	0.157
AST/ALT	1.384	0.932–2.055	0.107
Creatinine (μmol/L)	1.007	1.002–1.011	0.004
LDH (U/L)	1.004	1.001–1.007	0.006
Homocysteine(μmol/L)	1.005	0.996–1.015	0.252
Albumin(g/L)	0.874	0.823–0.927	<0.001
Bilateral lung lesions	11.009	2.536–47.781	0.001	7.352	1.578–34.249	0.011
Pleural effusion	3.667	2.173–6.186	<0.001	2.512	1.397–4.517	0.002
Pericardial effusion	2.996	1.430–6.277	0.004

Notes: The data were calculated using logistic regression analysis. The statistically significant P values are in bold.

Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; CRP, C-reactive protein; 95% CI: 95% confidence interval; DBP, diastolic blood pressure; LDH, lactate dehydrogenase; OR, odds ratio; SBP, systolic blood pressure; WBC, white blood cell.

Figure 1 ROC curve of the constructed predictive model and single factors for predicting ARDS in patients with bacterial pneumonia.

Abbreviations: ARDS, acute respiratory distress syndrome; ROC, receiver-operating characteristic.

Figure 2 (a) Nomogram of the predictive model for predicting ARDS in patients with bacterial pneumonia. (b) Calibration plot.