AUTHOR=Cheng Hongtao , Li Jieyao , Wei Fangxin , Yang Xin , Yuan Shiqi , Huang Xiaxuan , Zhou Fuling , Lyu Jun 

TITLE=A risk nomogram for predicting prolonged intensive care unit stays in patients with chronic obstructive pulmonary disease

JOURNAL=Frontiers in Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1177786

DOI=10.3389/fmed.2023.1177786

ISSN=2296-858X

ABSTRACT=Abstract
Background: Providing intensive care is increasingly expensive, and the aim of this study was to construct a risk column line graph (nomograms)for prolonged length of stay (LOS) in the intensive care unit (ICU) for patients with chronic obstructive pulmonary disease (COPD).
Methods: This study included 4940 patients, and the data set was randomly divided into training (n=3458) and validation (n=1482) sets at a 7:3 ratio. First, least absolute shrinkage and selection operator (LASSO) regression analysis was used to optimize variable selection by running a tenfold k-cyclic coordinate descent. Second, a prediction model was constructed using multifactorial logistic regression analysis, and a potential predictor was added based on the literature and clinical practice experience, and potential predictors were introduced to construct the model. Third, the model was validated using receiver operating characteristic (ROC) curves, Hosmer-Lemeshow tests, calibration plots, and decision-curve analysis (DCA), and was further internally validated. 
Results: This study selected 11 predictors: sepsis, renal replacement therapy, cerebrovascular disease, respiratory failure, ventilator associated pneumonia, norepinephrine, bronchodilators, invasive mechanical ventilation, electrolytes disorders, Glasgow Coma Scale score and body temperature. The models constructed using these eleven predictors indicated good predictive power, with the areas under the ROC curves being 0.826 (95%CI:0.809-0.842) and 0.827 (95%CI:0.802-0.853) in the training and validation sets, respectively. The Hosmer-Lemeshow test indicated a strong agreement between the predicted and observed probabilities in the training (2=8.21, p=0.413) and validation (2=0.64, p=0.999) sets. In addition, decision-curve analysis suggested that the model had good clinical validity. 
Conclusion: This study has constructed and validated original and dynamic nomograms for prolonged ICU stay in patients with COPD using eleven easily collected parameters. These nomograms can provide useful guidance to medical and nursing practitioners in ICUs and help reduce the disease and economic burdens on patients.