Abstract
OBJECTIVE: This study aimed to identify short-term mortality risk factors for patients with acute respiratory failure (ARF) the MIMIC-IV database, construct a prognostic nomogram and evaluate its predictive performance compared to conventional scoring systems. METHODS: Clinical data from patients diagnosed with ARF were retrospectively collected from the MIMIC-IV database and randomly divided into training and validation groups. The variables were selected via the Lasson regression, and a nomogram was constructed. The nomogram was compared with acute physiology score III (APSIII), simplified acute physiology scores II (SAPS II) and oxford acute severity of illness score (OASIS) model via the C-index, area under the receiver operating characteristic curve (ROC), net reclassification index (NRI), integrated discrimination improvement index (IDI), decision curve analysis (DCA). RESULTS: A total of 559 patients were included. The study identified nine independent risk factors: age (HR: 1.022, 95% CI: 1.008-1.036, P = 0.002), WBC (HR: 1.060, 95% CI:1.033-1.086, P < 0.001), glucose levels (HR:1.002, 95% CI: 1.001-1.004, P = 0.003), temperature (HR: 0.544, 95% CI: 0.430-0.689, P < 0.001), metastatic solid tumor (HR: 2.138, 95% CI: 1.045-4.372, P = 0.037), malignant cancer (HR: 2.455, 95% CI: 1.456-4.138, P < 0.001), diabetes without chronic complications (HR: 0.288, 95% CI: 0.157-0.807, P < 0.001), cerebrovascular disease (HR: 2.156, 95% CI: 1.180-3.940, P = 0.012), dementia (HR: 2.23, 95% CI: 1.132-4.392, P = 0.020). The nomogram demonstrated strong discriminative performance with C-indices of 0.782 and 0.749 in the training and validation sets, respectively. The AUC for the Training and Validation cohorts were 0.811 (APS III: 0.652; SAPS II: 0.672; OASIS: 0.624) and 0.790 (APS III: 0.634; SAPS II: 0.652; OASIS: 0.609), respectively. The nomogram also significantly outperformed traditional scoring systems, as evidenced by positive NRI and IDI values. CONCLUSION: The newly developed nomogram exhibits superior predictive capability to traditional scoring systems (APS III, SAPS II and OASIS scores), offering clinicians a practical and reliable tool for accurately assessing short-term mortality risks in ICU patients with ARF.