The risk factors of early enteral nutrition intolerance in elderly patients with severe pneumonia and construction of nomogram model
Peng Siqin
Yu Hehua
Chen Hong
Li Feifei
Abstract：Objective To explore the risk factors of early enteral nutrition(EEN)intolerance in elderly patients with severe pneumonia,and to construct and verify a nomogram model.Methods A total of 209 elderly patients with severe pneumonia in The Second Affiliated Hospital of Naval Medical University of Chinese People's Liberation Army from January 2023 to January 2025 were selected.EEN tolerance of patients was recorded.According to the presence or absence of EEN intolerance symptoms,the patients were divided into tolerance group and intolerance group.The risk factors of EEN intolerance were analyzed and a nomogram was drawn.The receiver operating characteristic curve was used to test the predictive efficacy of the nomogram model.Results Among 209 elderly patients with severe pneumonia,86 cases had EEN intolerance.The incidence was 41.1％(86/209).Among the patients with EEN intolerance,74.4％(64/86)had single symptom,mainly diarrhea,gastric retention and abdominal distension,25.6％(22/86)had two or more symptoms,and EEN intolerance mainly occurred on the first and second day of the implementation of EEN.Old age,late start of enteral nutrition,high clinical pulmonary infection score(CPIS),long duration of mechanical ventilation and intermittent injection were independent risk factors for EEN intolerance in elderly patients with severe pneumonia(all P＜0.05).The prediction model of EEN intolerance in elderly patients with severe pneumonia was constructed according to the influencing factors screened from the results of Logistic regression analysis.Logit(P)=-15.541+0.923 × age+0.966 × initiation time of enteral nutrition+0.854 × CPIS+0.338 × mechanical ventilation time-0.959 × feeding mode.Hosmer-Lemeshow goodness of fit test showed that x2=4.138,degree of freedom=8,P=0.830.The nomogram showed that when the sum of the scores of each influencing factor was more than 144,the risk of EEN intolerance was more than 80％.The consistency index of the nomogram model was 0.888,and the area under the curve for predicting EEN intolerance in elderly patients with severe pneumonia was 0.888(95％confidence interval:0.837-0.927).Conclusion The risk factors of EEN intolerance in elderly patients with severe pneumonia include old age,late start time of enteral nutrition,high CPIS,long duration of mechanical ventilation and intermittent injection.The nomogram model based on the above influencing factors has a high predictive efficiency for EEN intolerance in elderly patients with severe pneumonia,which is helpful for medical staff to accurately identify high-risk groups.It has guiding significance for the improvement of nutrition management strategy.
Keywords：Severe pneumoniaEarly enteral nutritionIntoleranceInfluencing factors
Publication Date：2025-12-18
Online Publishing Date：2026-09-14(First online date of this platform, not the publication date of the document)
Pages：5( 1789-1793 )