The nomogram model of type Ⅱ acute respiratory failure in patients with acute exacerbation of chronic obstructive pulmonary disease

Wang Miaomiao; Kong Fang; He Zhijun

doi:10.3969/j.issn.1674-3245.2025.03.011

Abstract：Objective To investigate the predictive value of serum N-terminal pro-B-type natriuretic peptide(NT-ProBNP),D-dimer(D-D),and procalcitonin(PCT)levels for the occurrence of type Ⅱ acute respiratory failure in patients with acute exacerbation of chronic obstructive pulmonary disease(COPD),and to construct a nomogram prediction model.Methods A retrospective analysis was performed of 380 patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)who were treated in our hospital from March 2023 to December 2023 was conducted as the training set.These patients were used as the training set.They were divided into a respiratory failure group and a non-respiratory failure group according to whether they developed type Ⅱ acute respiratory failure.The general data and test indicators of the two groups of patients were analyzed,risk factor analysis was carried out,and a Nomogram model was constructed.The validation set,according to a 3∶7 ratio with the training set,selected 163 patients with acute exacerbation of COPD who were treated in our hospital from January 2024 to July 2024 for internal validation of the model.Results Among the 380 patients in the training set,124 cases developed type Ⅱ acute respiratory failure,with an incidence rate of 32.63％.Multivariate Logistic regression analysis showed that age,the number of acute exacerbations within 1 year,the percentage of forced expiratory volume in the first second as a percentage of the predicted value,the Chronic Health Evaluation Ⅱ(CHEⅡ)score,the Global Initiative for Chronic Obstructive Lung Disease(GOLD)grade,white blood cell count,C-reactive protein,NT-ProBNP,D-D,and PCT levels were risk factors for type Ⅱ acute respiratory failure in patients with acute exacerbation of COPD(P＜0.05).The Hosmer-Lemeshow(H-L)test showed that x2=4.861 and P=0.805.The area under the curve(AUC)of the receiver operating characteristic(ROC)curve was 0.915(95％CI=0.885～0.945,P＜0.05),with a sensitivity of 0.879 and a specificity of 0.844.The calibration curve of the model calibration plot was close to the standard curve,indicating good consistency of the model.The results of the H-L test in the validation set showed that x2=4.360 and P=0.823.The AUC of the prediction model was 0.898(95％CI=0.865～0.931,P＜0.05),with a sensitivity of 0.855 and a specificity of 0.801.Conclusion The Nomogram model based on serum NT-ProBNP,D-D and PCT levels has good predictive value for type Ⅱ acute respiratory failure in AECOPD patients,potentially aiding early clinical identification of high-risk individuals and reducing complications.