Development and Validation of a Nomogram to Predict risk of Sepsis in Non-ventilator Hospital- Acquired Pneumonia

Objective: To identify risk factors for progression to sepsis in patients with non-ventilator hospital-acquired pneumonia (NV-HAP) and develop a practical and accurate nomogram to improve clinical outcomes. Methods: We retrospectively enrolled 408 hospitalized patients diagnosed with hospital-acquired pneumonia at Peking University Third Hospital between January 2017 and December 2021. Clinical and laboratory data were collected, and patients were randomly assigned to a training cohort and a validation cohort. Univariate and multivariate logistic regression analyses were performed in the training cohort to identify independent risk factors associated with progression to sepsis. A predictive nomogram was then constructed based on these independent predictors and validated using the validation cohort. Results: A total of 368 patients were ultimately included. Multivariate logistic regression analysis identified male sex (OR = 2.22, 95% CI: 1.09–4.51), coagulation dysfunction (OR = 2.35, 95% CI: 1.04–5.30), acute myocardial infarction (OR = 8.58, 95% CI: 2.10–35.04), chronic kidney disease (OR = 2.73, 95% CI: 1.15–6.51), underlying respiratory disease (OR = 0.31, 95% CI: 0.12–0.79), oxygenation index (OR = 0.99, 95% CI: 0.99–1.00), platelet count (OR = 0.99, 95% CI: 0.98–0.99), and total bilirubin (OR = 1.03, 95% CI: 1.01–1.06) as independent predictors for progression to sepsis in NV-HAP patients. The nomogram demonstrated good predictive performance, with C-index values of 0.73 in the training cohort and 0.64 in the validation cohort. Calibration curves indicated acceptable agreement between predicted and actual outcomes, and decision curve analysis confirmed favorable clinical utility in both cohorts. Conclusion: In patients with NV-HAP, clinicians should pay particular attention to specific independent risk factors identified in this study, such as male sex, coagulation dysfunction, acute myocardial infarction, chronic kidney disease, underlying respiratory diseases, decreased oxygenation index, thrombocytopenia, and elevated total bilirubin. The developed nomogram effectively predicts the risk of progression to sepsis, providing clinicians with a practical tool for timely intervention and potentially improving patient outcomes.