Construction of nosocomial pulmonary infection prediction model for acute pesticide poisoning_West China Medical Journal

Authors：

ZHAO Hong ¹ , XING Jingjing ¹ , PAN Huiqing ¹ , CHEN Meng ² , WEI Na ³ , TANG Xiaolei ⁴ ,  YE Sheng ¹

1. Emergency Department, the Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241000, P. R. China;
2. Graduate School, Wannan Medical College, Wuhu, Anhui 241000, P. R. China;
3. Emergency Department, the First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241000, P. R. China;
4. Translational Medicine Centre, the Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241000, P. R. China;

Corresponding author：

YE Sheng, Email: yesheng0553@163.com

Keywords：

Acute pesticide poisoning; nosocomial pulmonary infection; age; activities of daily living score; prediction effect

DOI：

10.7507/1002-0179.202310062

Video：

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Objective To explore the risk factors of nosocomial pulmonary infection in acute pesticide poisoning. Methods The clinical data of patients with acute pesticide poisoning hospitalized in the Emergency Department of the First Affiliated Hospital of Wannan Medical College and the Second Affiliated Hospital of Wannan Medical College between January 1, 2021 and September 30, 2023 were retrospectively analyzed. Patients were divided into pulmonary infection group and non-pulmonary infection group according to whether they had pulmonary infection during hospital. Multiple logistic regression was used to analyze the independent risk factors of nosocomial pulmonary infection in patients with acute pesticide poisoning, and a risk prediction model (nomogram) was constructed. The predictive efficacy of nomogram and independent predictors in nosocomial pulmonary infection were analyzed by using the receiver operating characteristic curve. Calibration curve and decision curve were used to evaluate the differentiation and clinical application value of the model. Results A total of 189 patients with acute pesticide poisoning were included in the study, with an average age of (58.12±18.45) years old, 98 males (51.85%) and 91 females (48.15%). There were 36 cases (19.05%) of pulmonary infection. Multiple logistic regression analysis showed that age [odds ratio (OR)=1.030, 95% confidence interval (CI) (1.001, 1.060), P=0.040], type 2 diabetes mellitus [OR=2.770, 95%CI (1.038, 7.393), P=0.042], ischemic cerebrovascular disease [OR=3.213, 95%CI (1.101, 9.376), P=0.033], white blood cell count [OR=1.080, 95%CI (1.013, 1.152), P=0.019], activities of daily living score [OR=0.981, 95%CI (0.965, 0.998), P=0.024] were independent predicting factors for nosocomial pulmonary infection in acute pesticide poisoning. The area under the curve of nosocomial pulmonary infection in patients with acute pesticide poisoning predicted by nomogram based on the above factors was 0.813 (P<0.001). The calibration curve showed that the prediction probability was consistent with the actual occurrence probability (P=0.912), and the decision curve showed that the nomogram had good clinical application value. Conclusions Age, activities of daily living score, type 2 diabetes mellitus, ischemic cerebrovascular disease, and white blood cell count are independent predictors of nosocomial pulmonary infection in acute pesticide poisoning. The nomogram constructed based on them has good differentiation and consistency, which can provide basis for early identification and intervention of clinical staff.

Citation： ZHAO Hong, XING Jingjing, PAN Huiqing, CHEN Meng, WEI Na, TANG Xiaolei, YE Sheng. Construction of nosocomial pulmonary infection prediction model for acute pesticide poisoning. West China Medical Journal, 2023, 38(11): 1655-1661. doi: 10.7507/1002-0179.202310062 Copy

1.	旷聃, 彭琦, 王琳, 等. 2012 至 2021 年成都市农药中毒流行病学特征分析. 中华劳动卫生职业病杂志, 2023, 41(6): 451-456.
2.	房云, 季新强, 张非若, 等. 2007 至 2012 年北京市农药中毒报告的情况分析. 中华劳动卫生职业病杂志, 2014, 32(1): 55-57.
3.	Ko S, Cha ES, Choi Y, et al. The burden of acute pesticide poisoning and pesticide regulation in Korea. J Korean Med Sci, 2018, 33(31): e208.
4.	诸葛毅, 俎德玲, 祝进, 等. 急性有机磷农药中毒患者机械通气时肺部感染的病原菌研究. 中华劳动卫生职业病杂志, 2006, 24(2): 118-119.
5.	余凌云, 吴志德, 魏坦明, 等. 急性农药中毒患者医院感染危险因素分析. 中华医院感染学杂志, 2015, 25(9): 2052-2054.
6.	Melsen WG, Rovers MM, Groenwold RH, et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis, 2013, 13(8): 665-671.
7.	中国医师协会急诊医师分会. 急性有机磷农药中毒诊治临床专家共识(2016). 中国急救医学, 2016, 36(12): 1057-1065.
8.	Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis, 2016, 63(5): e61-e111.
9.	Liu JY, Dickter JK. Nosocomial infections: a history of hospital-acquired infections. Gastrointest Endosc Clin N Am, 2020, 30(4): 637-652.
10.	Wang R, Zhang J, He M, et al. Procalcitonin as a biomarker of nosocomial pneumonia in aneurysmal subarachnoid hemorrhage patients treated in neuro-ICU. Clin Neurol Neurosurg, 2023, 231: 107870.
11.	高雅, 王欣, 李培, 等. 2009 至 2018 年天津市农药中毒流行病学分析. 中华劳动卫生职业病杂志, 2021, 39(4): 282-285.
12.	Wang N, Jiang Q, Han L, et al. Epidemiological characteristics of pesticide poisoning in Jiangsu Province, China, from 2007 to 2016. Sci Rep, 2019, 9(1): 8604.
13.	王宁, 王博深, 田质光, 等. 徐州市 2005 至 2017 年农药中毒流行病学特征分析. 中华劳动卫生职业病杂志, 2018, 36(12): 926-929.
14.	Noghrehchi F, Dawson AH, Raubenheimer JE, et al. Role of age-sex as underlying risk factors for death in acute pesticide self-poisoning: a prospective cohort study. Clin Toxicol (Phila), 2022, 60(2): 184-190.
15.	Zhang D, Zhuo H, Yang G, et al. Postoperative pneumonia after craniotomy: incidence, risk factors and prediction with a nomogram. J Hosp Infect, 2020, 105(2): 167-175.
16.	Buurman BM, Frenkel WJ, Abu-Hanna A, et al. Acute and chronic diseases as part of multimorbidity in acutely hospitalized older patients. Eur J Intern Med, 2016, 27: 68-75.
17.	Arai J, Kato J, Toda N, et al. Risk factors of poor prognosis and impairment of activities of daily living in patients with hemorrhagic gastroduodenal ulcers. BMC Gastroenterol, 2021, 21(1): 16.
18.	Modi AR, Kovacs CS. Hospital-acquired and ventilator-associated pneumonia: diagnosis, management, and prevention. Cleve Clin J Med, 2020, 87(10): 633-639.
19.	徐挺, 陈建良, 董子龙. 神经重症患者肺部感染的危险因素分析. 中华神经医学杂志, 2020, 19(1): 54-58.
20.	Liu YX, Cao QM, Ma BC. Pathogens distribution and drug resistance in patients with acute cerebral infarction complicated with diabetes and nosocomial pulmonary infection. BMC Infect Dis, 2019, 19(1): 603.
21.	Shi K, Wood K, Shi FD, et al. Stroke-induced immunosuppression and poststroke infection. Stroke Vasc Neurol, 2018, 3(1): 34-41.
22.	Mu Y, Hu B, Gao N, et al. Prognostic value of the neutrophil-to-lymphocyte ratio in acute organophosphorus pesticide poisoning. Open Life Sci, 2021, 16(1): 703-710.
23.	Feng S, Gao J, Li Y. A retrospective analysis of leucocyte count as a strong predictor of survival for patients with acute paraquat poisoning. PLoS One, 2018, 13(7): e201200.
24.	何群鹏, 姚小丹, 祁玮, 等. NLR 联合 KIM-1 检测对有机磷农药中毒急性肾损伤患者的临床意义. 中国急救复苏与灾害医学杂志, 2022, 17(4): 478-481.

1. 旷聃, 彭琦, 王琳, 等. 2012 至 2021 年成都市农药中毒流行病学特征分析. 中华劳动卫生职业病杂志, 2023, 41(6): 451-456.
2. 房云, 季新强, 张非若, 等. 2007 至 2012 年北京市农药中毒报告的情况分析. 中华劳动卫生职业病杂志, 2014, 32(1): 55-57.
3. Ko S, Cha ES, Choi Y, et al. The burden of acute pesticide poisoning and pesticide regulation in Korea. J Korean Med Sci, 2018, 33(31): e208.
4. 诸葛毅, 俎德玲, 祝进, 等. 急性有机磷农药中毒患者机械通气时肺部感染的病原菌研究. 中华劳动卫生职业病杂志, 2006, 24(2): 118-119.
5. 余凌云, 吴志德, 魏坦明, 等. 急性农药中毒患者医院感染危险因素分析. 中华医院感染学杂志, 2015, 25(9): 2052-2054.
6. Melsen WG, Rovers MM, Groenwold RH, et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis, 2013, 13(8): 665-671.
7. 中国医师协会急诊医师分会. 急性有机磷农药中毒诊治临床专家共识(2016). 中国急救医学, 2016, 36(12): 1057-1065.
8. Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis, 2016, 63(5): e61-e111.
9. Liu JY, Dickter JK. Nosocomial infections: a history of hospital-acquired infections. Gastrointest Endosc Clin N Am, 2020, 30(4): 637-652.
10. Wang R, Zhang J, He M, et al. Procalcitonin as a biomarker of nosocomial pneumonia in aneurysmal subarachnoid hemorrhage patients treated in neuro-ICU. Clin Neurol Neurosurg, 2023, 231: 107870.
11. 高雅, 王欣, 李培, 等. 2009 至 2018 年天津市农药中毒流行病学分析. 中华劳动卫生职业病杂志, 2021, 39(4): 282-285.
12. Wang N, Jiang Q, Han L, et al. Epidemiological characteristics of pesticide poisoning in Jiangsu Province, China, from 2007 to 2016. Sci Rep, 2019, 9(1): 8604.
13. 王宁, 王博深, 田质光, 等. 徐州市 2005 至 2017 年农药中毒流行病学特征分析. 中华劳动卫生职业病杂志, 2018, 36(12): 926-929.
14. Noghrehchi F, Dawson AH, Raubenheimer JE, et al. Role of age-sex as underlying risk factors for death in acute pesticide self-poisoning: a prospective cohort study. Clin Toxicol (Phila), 2022, 60(2): 184-190.
15. Zhang D, Zhuo H, Yang G, et al. Postoperative pneumonia after craniotomy: incidence, risk factors and prediction with a nomogram. J Hosp Infect, 2020, 105(2): 167-175.
16. Buurman BM, Frenkel WJ, Abu-Hanna A, et al. Acute and chronic diseases as part of multimorbidity in acutely hospitalized older patients. Eur J Intern Med, 2016, 27: 68-75.
17. Arai J, Kato J, Toda N, et al. Risk factors of poor prognosis and impairment of activities of daily living in patients with hemorrhagic gastroduodenal ulcers. BMC Gastroenterol, 2021, 21(1): 16.
18. Modi AR, Kovacs CS. Hospital-acquired and ventilator-associated pneumonia: diagnosis, management, and prevention. Cleve Clin J Med, 2020, 87(10): 633-639.
19. 徐挺, 陈建良, 董子龙. 神经重症患者肺部感染的危险因素分析. 中华神经医学杂志, 2020, 19(1): 54-58.
20. Liu YX, Cao QM, Ma BC. Pathogens distribution and drug resistance in patients with acute cerebral infarction complicated with diabetes and nosocomial pulmonary infection. BMC Infect Dis, 2019, 19(1): 603.
21. Shi K, Wood K, Shi FD, et al. Stroke-induced immunosuppression and poststroke infection. Stroke Vasc Neurol, 2018, 3(1): 34-41.
22. Mu Y, Hu B, Gao N, et al. Prognostic value of the neutrophil-to-lymphocyte ratio in acute organophosphorus pesticide poisoning. Open Life Sci, 2021, 16(1): 703-710.
23. Feng S, Gao J, Li Y. A retrospective analysis of leucocyte count as a strong predictor of survival for patients with acute paraquat poisoning. PLoS One, 2018, 13(7): e201200.
24. 何群鹏, 姚小丹, 祁玮, 等. NLR 联合 KIM-1 检测对有机磷农药中毒急性肾损伤患者的临床意义. 中国急救复苏与灾害医学杂志, 2022, 17(4): 478-481.

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