DEVELOPMENT OF AN IN-HOSPITAL MORTALITY PREDICTION MODEL FOR PATIENTS WITH MULTIDRUG-RESISTANT ACINETOBACTER BAUMANNII PNEUMONIA: A PROSPECTIVE COHORT STUDY AT CHO RAY HOSPITAL
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Abstract
Background: Pneumonia caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) is a leading cause of mortality in intensive care units (ICUs). In Vietnam, carbapenem resistance exceeds 80%, and reported in-hospital mortality ranges from 30% to 50%. Existing mortality prediction tools may not adequately reflect local clinical characteristics.
Objective: To develop and internally validate a prediction model for in-hospital mortality among ICU patients with MDR-AB pneumonia.
Subjects and Methods: A prospective cohort study was conducted at Cho Ray Hospital from January 2024 to April 2025. Adult patients (≥18 years) diagnosed with ventilator-associated pneumonia (VAP) or hospital-acquired pneumonia (HAP) caused by MDR-AB were enrolled. Independent predictors of in-hospital mortality were identified using multivariable logistic regression. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow goodness-of-fit test, and internal validation with bootstrapping.
Results: A total of 182 patients were included, with an in-hospital mortality rate of 50%. Three independent variables were retained in the final model: diabetes mellitus (OR = 0.469, p = 0.047), chronic obstructive pulmonary disease (COPD) (OR = 0.367, p = 0.016), and lymphocyte count (OR = 0.551, p = 0.020). The prediction model demonstrated moderate discrimination (AUC = 0.712; 95% CI: 0.635-0.789). A nomogram was developed to facilitate bedside application.
Conclusion: A mortality prediction model incorporating diabetes mellitus, COPD, and lymphocyte count showed acceptable discrimination and calibration, suggesting potential clinical utility for early risk stratification of ICU patients with MDR-AB pneumonia.
Keywords
Pneumonia, hospital-acquired pneumonia, A. baumannii
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References
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