Value of CCI combined with miR-21-5p in predicting the prognosis of elderly patients undergoing mechanical ventilation

doi:10.3760/cma.j.issn.1007-1245.2024.18.015

Abstract

Abstract:

Objective　To evaluate the value of Charlson Comorbidity Index (CCI) combined with microRNA-21-5p (miR-21-5p) in predicting the prognosis of elderly patients undergoing mechanical ventilation. Methods　A total of 280 elderly patients who received mechanical ventilation in the emergency department of Hanzhong People's Hospital from April 2018 to December 2023 were retrospectively selected as the study objects. According to the survival status at one-month of follow-up, the patients were divided into a survival group (208 cases) and a death group (72 cases). There were 135 males and 73 females in the survival group, with a body mass index (BMI) of (22.46±2.57) kg/m². There were 48 males and 24 females in the death group, with a BMI of (22.19±3.01) kg/m². The general data and clinical characteristics (gender, BMI, smoking history, causes of respiratory failure, mechanical ventilation time, CCI total score, and miR-21-5p expression level) were compared between the two groups. Multivariate logistic regression model was used to analyze the influencing factors of prognosis. The receiver operating characteristic curve (ROC) was used to analyze the predictive efficacies of CCI total score and miR-21-5p expression level for the prognosis of elderly patients undergoing mechanical ventilation. Independent sample t test and χ² test were used. Results　There was no statistically significant difference between the two groups in terms of gender, BMI, smoking history, or causes of respiratory failure (all P>0.05). The mechanical ventilation time [(12.60±3.82) d], the total score of CCI [(10.43±3.35) points], and the expression level of miR-21-5p [(3.54±1.09)] in the death group were higher than those in the survival group [(10.31±3.40) d, (5.91±2.17) points, and (2.31±0.73)], with statistically significant differences (all P<0.05). Multivariate logistic regression analysis showed that the total score of CCI and the expression level of miR-21-5p were independent predictors of death (both P<0.05). The areas under the curves (AUCs) (95%CI) of CCI total score and miR-21-5p expression level to predict the prognosis of elderly patients undergoing mechanical ventilation were 0.859 (0.806-0.913) and 0.825 (0.759-0.890), respectively, and the combined AUC (95%CI) was 0.946 (0.919-0.973). Conclusion　The total CCI score combined with expression level of miR-21-5p can effectively predict the one-month mortality risk in elderly patients undergoing mechanical ventilation, which has important reference value for clinical decision-making.

Key words:

Charlson Comorbidity Index, miR-21-5p, Mechanical ventilation, Prognostic prediction

摘要：

目的　本研究旨在评估Charlson并发症指数（CCI）联合microRNA-21-5p（miR-21-5p）在预测老年机械通气患者预后中的价值。方法　回顾性选取2018年4月至2023年12月在汉中市人民医院急诊科接受机械通气治疗的280例老年患者作为研究对象。根据随访1个月的生存状况，将患者分为存活组（208例）和死亡组（72例）。存活组男135例，女73例；体重指数（BMI）（22.46±2.57）kg/m²。死亡组男48例，女24例；BMI（22.19±3.01）kg/m²。比较两组一般资料和临床特征（性别、BMI、吸烟史、呼吸衰竭原因、机械通气时间、CCI总分、miR-21-5p表达水平）；采用多因素logistic回归分析患者预后的影响因素；采用受试者操作特征曲线（ROC）分析CCI总分、miR-21-5p表达水平对老年机械通气患者预后的预测效能。采用独立样本t检验和χ²检验。结果　两组性别、BMI、吸烟史和呼吸衰竭原因比较，差异均无统计学意义（均P>0.05）。死亡组机械通气时间［（12.60±3.82）d］、CCI总分［（10.43±3.35）分］、miR-21-5p表达水平［（3.54±1.09）］均高于存活组［（10.31±3.40）d、（5.91±2.17）分、（2.31±0.73）］，差异均有统计学意义（均P<0.05）。多因素logistic回归分析显示，CCI总分和miR-21-5p表达水平是独立预测死亡的因素（均P<0.05）。CCI总分、miR-21-5p表达水平预测老年机械通气患者预后的曲线下面积（AUC）（95%CI）分别为0.859（0.806～0.913）、0.825（0.759～0.890），两者联合使用的AUC（95%CI）为0.946（0.919～0.973）。结论　CCI总分联合miR-21-5p表达水平可有效预测老年机械通气患者1个月内的死亡风险，对临床治疗决策具有重要参考价值。

关键词:

Charlson并发症指数, miR-21-5p, 机械通气, 预后预测

Wang Jia, Chen Xiaofeng.

Value of CCI combined with miR-21-5p in predicting the prognosis of elderly patients undergoing mechanical ventilation [J]. International Medicine and Health Guidance News, 2024, 30(18): 3062-3066.

王佳陈晓凤.

CCI联合miR-21-5p预测老年机械通气患者预后的价值 [J]. 国际医药卫生导报, 2024, 30(18): 3062-3066.

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