Predictors of pulmonary infection during hospitalization in patients with chronic heart failure and development of a predictive model

doi:10.3969/j.issn.1006-7795.2026.04.019

Abstract

Abstract: ObjectiveTo investigate the risk factors for pulmonary infection (PI) during hospitalization in patients with chronic heart failure (CHF) and to develop a predictive model based on these findings, thereby providing a reference for early identification of high-risk individuals and formulation of personalized intervention strategies. MethodsA retrospective study was conducted enrolling 181 CHF patients admitted from March 2022 to March 2025. Patients were grouped based on whether they developed PI during hospitalization, forming a PI group and a non-PI group. Baseline characteristics and relevant examination data were compared between groups. Variables showing significant differences were subjected to least absolute shrinkage and selection operator (LASSO) regression for variable selection. A multivariate Logistic regression model analyzed factors influencing PI occurrence during hospitalization. The SHAP-interpreted CatBoost model ranked variable importance, and a receiver operating characteristic (ROC) curve risk prediction model was constructed based on the finalized key variables. ResultsAmong 181 CHF patients hospitalized, 51 (28.18%) developed PI. The PI group exhibited statistically significant differences compared to the non-PI group in smoking history, comorbid pulmonary diseases, invasive procedures, heart function classification, and mechanical ventilation (P < 0.05). The PI group exhibited higher white blood cell (WBC), N-terminal pro-B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP), and procalcitonin (PCT) levels compared to the non-PI group, while the left ventricular ejection fraction (LVEF) was lower in the PI group (P < 0.05). Seven important influencing factors were obtained by least absolute shrinkage and selection operator（LASSO） regression : pulmonary disease, mechanical ventilation, WBC, NT-proBNP, CRP, PCT, LVEF, and there was no collinearity problem, which were all important variables affecting the occurrence of PI in CHF patients during hospitalization. NT-proBNP (OR=1.044,95 % CI : 1.017－1.071), CRP (OR=1.386,95 % CI : 1.139－1.686), PCT (OR=29.223,95 % CI : 1.512－564.776) and LVEF (OR=0.814,95 % CI : 0.719－0.921) were independent influencing factors of PI in CHF patients during hospitalization (NT-proBNP>CRP > LVEF > PCT). The area under the ROC curve of combined prediction reached 0.937 (95 % CI : 0.894－0.979), which was significantly higher than that of single index (P<0.05). ConclusionThere is a risk of PI in CHF patients during hospitalization. The study suggests that it is related to NT-proBNP, CRP, PCT and LVEF. Based on this, it is feasible to construct a prediction model, which can help identify high-risk patients in the early stage of clinical practice and provide scientific guidance for individualized intervention.

Key words: chronic heart failure, pulmonary infection, influencing factors, predictive model, left ventricular ejection fraction, mechanical ventilation

CLC Number:

R563.1

Sun Yao, Hao Jingjing, Liu Yufeng, Guo Hebing, Zhong Xiaoxi, Liu Jingyuan. Predictors of pulmonary infection during hospitalization in patients with chronic heart failure and development of a predictive model[J]. Journal of Capital Medical University, 2026, 47(4): 783-791.

References

［1］郭凯楠, 朱红燕, 李延鑫. 基于心功能分级分析老年慢性心力衰竭患者肺部感染的影响因素［J］. 中华老年多器官疾病杂志, 2025, 24(9): 668－672.
［2］费蕾, 高明昕, 吴曙华, 等. 老年冠心病并发心力衰竭患者院内肺部感染影响因素及风险预测模型构建［J］. 中华老年心脑血管病杂志, 2024, 26(11): 1277－1280.
［3］王国玉, 巴春贺, 李彤, 等. 老年慢性心力衰竭患者肺部感染的危险因素及其对PCT、NT-proBNP及氧化应激指标的影响［J］. 中南医学科学杂志, 2023, 51(1): 110－113.
［4］李佳红, 谭化, 赵雅丽, 等. 25-(OH)D3、pro-ADM、CD54在老年慢性心力衰竭并发肺部感染患者血清中的水平及与病［J］. 检验医学与临床, 2025, 22(18): 2475－2480.
［5］左路广, 黄冠杰,詹明华,等. 慢性心力衰竭并发感染患者病原学及脑钠肽变化研究［J］. 实用临床医药杂志, 2021, 25 (19): 49-52.
［6］刘健, 王继成, 唐静, 等. 老年慢性心力衰竭合并肺部感染患者短期肺部感染再发的危险因素及其预测效能分析［J］. 山东医药, 2024, 64(17): 91－94.
［7］Zheng F. Pathogenic characteristics of pulmonary infection in hospitalized patients with chronic heart failure and diagnostic value of sTREM-1, sCD163, and sTWEAK［J］. Pak J Med Sci, 2022, 38(3Part-I): 536－541.
［8］吴文慧, 张娜, 吕倩, 等. 老年慢性心力衰竭合并肺部感染患者的临床特点及Nomogram预测模型的构建［J］. 中国急救复苏与灾害医学杂志, 2024, 19(11): 1478－1481, 1495.
［9］中华医学会老年医学分会心血管疾病学组, 《老年慢性心力衰竭诊治中国专家共识》编写组. 老年人慢性心力衰竭诊治中国专家共识(2021)［J］. 中华老年医学杂志, 2021, 40(5): 550－561.
［10］王建爱, 于蕾, 罗育红, 等. 外周血miR-21、MIP-2、PCT及IL-6在冠心病慢性心力衰竭合并肺部感染患者中的表达及意义［J］. 分子诊断与治疗杂志, 2023, 15(12): 2167－2171.
［11］中华人民共和国卫生部. 医院感染诊断标准(试行)［J］. 中华医学杂志, 2001, 81(5): 314－320.
［12］Tippett A, Ess G, Hussaini L, et al. Influenza vaccine effectiveness pre-pandemic among adults hospitalized with congestive heart failure or chronic obstructive pulmonary disease and older adults［J］. Clin Infect Dis, 2024, 78(4): 1065－1072.
［13］马佳佳, 李勇, 高肖坤, 等. 老年慢性心力衰竭合并糖尿病患者发生肺部感染的危险因素及其预测模型构建［J］. 中华医院感染学杂志, 2024, 34(10): 1458－1461.
［14］申采玉, 王帅, 周锐盈, 等. 慢性心力衰竭合并肺部感染患者院内死亡风险预测: 基于可解释性机器学习方法［J］. 南方医科大学学报, 2024, 44(6): 1141－1148.
［15］尚欣荣, 张晓红. 血清sST2和Gal-3对肺部感染合并心力衰竭的预测价值［J］. 标记免疫分析与临床, 2025, 32(7): 1332－1335, 1380.
［16］孟广蕊, 纪志芳, 田勇. 老年心力衰竭合并肺部感染病原菌分布及血清CRP、PCT水平变化［J］. 中国病原生物学杂志, 2023, 18(7): 821－824, 829.
［17］严向锋, 刘国龙. 血清HBP、pro-ADM及NT-proBNP对CHF患者肺部感染严重程度的诊断价值［J］. 中国基层医药, 2025, 32(2): 177－183.
［18］吕佳楠, 王亚楠, 李璐, 等. 老年慢性心力衰竭合并肺部感染患者预后不良的列线图预测模型构建［J］. 中国医刊, 2025, 60(1): 14－17.
［19］黄丹, 韩大伟, 张梅梅, 等. 慢性心力衰竭住院患者并发重度肺部感染临床特征分析及列线图预测模型构建［J］. 临床内科杂志, 2025, 42(4): 300－303.

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