A Nomogram Model for Post-Intubation Hypotension in Patients with Severe Pneumonia in the Emergency Department

Abstract

Background

Post-intubation hypotension (PIH) frequently occurs in the management of critically ill patients and is associated with prognosis. The study aimed to construct a prediction model for PIH events by analyzing risk factors in patients with severe pneumonia in the emergency department.

Methods

We retrospectively enrolled 572 patients with severe pneumonia diagnosed in the emergency department of West China Hospital of Sichuan University. Five hundred patients with severe pneumonia who underwent endotracheal intubation were included in the study. All patients were randomized according to 7:3 and divided into a training cohort (n=351) and a validation cohort (n=149). Risk factors for PIH were analyzed using Least Absolute Shrinkage and Selection Operator (LASSO) and multivariable logistic regression. Calibration curves, receiver operating characteristic (ROC) curve, and decision curve analysis were applied to assess the predictive model’s fitness, discrimination, and clinical utility.

Results

A total of 500 patients with severe pneumonia who underwent endotracheal intubation were enrolled in this study, and PIH occurred in 234 (46.8%) of these patients. Age, heart rate, systolic blood pressure, chronic obstructive pulmonary disease, acute physiology and chronic health evaluation II score, and induction agent use were identified as significant risk factors for the occurrence of PIH. Additionally, the body mass index was the opposite of the above. The area under the ROC curve (AUC) for the model was 0.856 (95% CI, 0.818–0.894) in the training cohort and 0.849 (95% CI, 0.788–0.910) in the validation cohort. The nomogram model was validated and demonstrated good calibration and high net clinical benefit. Finally, to facilitate application by clinicians, an online server has been set up which can be accessed free of charge via the website https://chinahospitals.shinyapps.io/DynNomapp/.

Conclusion

The nomogram is used for individualized prediction of patients with severe pneumonia prior to intubation and is simple to perform with high clinical value.

Keywords:

• post-intubation hypotension
• severe pneumonia
• prognosis
• induction agent
• nomogram

Data Sharing Statement

The datasets for this manuscript will be made available upon request, further inquiries can be directed to the corresponding author Yu Cao, [email protected].

Ethics Approval and Informed Consent

All procedures performed in studies involving human participants were performed in accordance with the Declaration of Helsinki and approved by the ethics committee of the West China Hospital of Sichuan University (No.2022-0493). The ethics committee of the West China Hospital of Sichuan University waived the need for written informed consent provided by participants due to the retrospective nature of the study. All patient data were analyzed anonymously, and no additional informed consent was required.

Acknowledgments

We sincerely thank the Information Management Department of West China Hospital of Sichuan University for their support in the data extraction process.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by a grant from the Peking Union Medical Foundation - Rui E (Rui Yi) Special Fund for Emergency Medicine Research (No. 22222012003).