[Predictive model for nosocomial pneumonia in intensive care units].
OBJECTIVE
Nosocomial pneumonia is the most common nosocomial infection in the intensive care units (ICUs) and contributes disproportionately to both poor outcomes and high cost of care in critically ill patients. In order to identify patients with greater risk of developing nosocomial pneumonia in ICUs, it is important to select the right preventive measures.


METHODS
It was an observational study of 2 prospective cohorts of patients staying in the ICU for 24 h or more: the main cohort (n=1,184) and the validation cohort (n=554). A predictive model was constructed with the data of the main cohort using a logistic regression. Receiver operating characteristic (ROC) curves and predictive values for different cut points were obtained with the data of both cohorts.


RESULTS
Eight variables were selected for the predictive model: parenteral nutrition, enteral nutrition, nasogastric intubation, tracheostomy, mechanical ventilation, previous surgery, coma and diabetes. In the main cohort, the model had a sensitivity of 81% and a specificity of 78.4% in predicting nosocomial pneumonia (Hosmer-Lemeshow statistic p=0.93; area under ROC curve=0.861; 95% confidence interval, 0.824-0.898). In the validation cohort, the area under ROC curve was 0.849 (95% confidence interval, 0.742-0.956).


CONCLUSIONS
The resulting model presents satisfactory results in both cohorts. In addition, the variables used are simple, routinely available, and familiar to clinicians.
Lapresta Moros
Carlos
C
Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Miguel Servet, Zaragoza, Spain. clapresta@salud.aragon.es
Solano Bernad
Víctor Manuel
VM
del Villar Belzunce
Adriana
A
Hernández Navarrete
María Jesús
MJ
Gómez-Juárez Sango
Ana
A
Arribas Llorente
José Luis
JL
D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D018410:Pneumonia, Bacterial / Q000453:epidemiology*; D011446:Prospective Studies