老年过敏性鼻炎患者哮喘共病风险预测列线图:多因素模型的构建与临床验证

Abstract

Abstract: Objective To investigate the influencing factors of bronchial asthma(BA)comorbidity in elderly patients with allergic rhinitis(AR)and to develop a nomogram prediction model for early identification of high-risk individuals and individualized prevention. Methods A total of 523 elderly patients with AR were enrolled from Meishan People's Hospital between January 2019 and December 2024. They were randomly divided into a training set(n=366)and a validation set(n=157)at a 7∶3 ratio. Patients were categorized into AR with BA comorbidity group and AR alone group based on the presence of BA. Least absolute shrinkage and selection operator(LASSO)regression was used for preliminary variable selection, followed by multivariate logistic regression to identify independent influencing factors. A nomogram was constructed based on these factors. Model discrimination was evaluated using receiver operating characteristic(ROC)curve, calibration was assessed using Hosmer-Lemeshow test and calibration curves, and clinical applicability was evaluated using decision curve analysis(DCA). Results Among the 523 elderly AR patients, 138(26.39%)had BA comorbidity. Multivariate logistic regression showed that family history of BA(OR=2.224, 95%CI:1.322-3.744), occupational dust exposure(OR=3.614, 95%CI:2.107-6.199), multiple allergens(OR=2.787, 95%CI:1.585-4.900), and irregular use of intranasal corticosteroids or antihistamines(OR=2.381)were independent influencing factors for BA comorbidity(P<0.05). The nomogram yielded an AUC of 0.759(95%CI:0.704-0.813)in the training set and 0.745(95%CI:0.650-0.832)in the validation set. The Hosmer-Lemeshow test indicated good model fit(training set P=0.244; validation set P=0.958), and calibration curves showed good agreement between predicted and observed probabilities. DCA demonstrated positive net clinical benefit across threshold probabilities of 0.090-0.610 in the training set and 0.080-0.900 in the validation set. Conclusion Family history of BA, occupational dust exposure, multiple allergens, and irregular medication use are independent risk factors for BA comorbidity in elderly AR patients. The nomogram constructed based on these factors exhibits good predictive performance and clinical applicability, providing a visual tool for early identification of high-risk individuals and facilitating individualized prevention and community-based stratified management.

Key words: Elderly, Allergic rhinitis, Bronchial asthma, Nomogram model

CLC Number:

R763

LIU Danfeng, PAN Qingchun, FENG Xuefei, LI Haoyi, REN Jian, LI Daibo. Development and validation of a nomogram for predicting asthma comorbidity in elderly patients with allergic rhinitis[J].Journal of Otolaryngology and Ophthalmology of Shandong University, 2026, 40(6): 54-62.

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Development and validation of a nomogram for predicting asthma comorbidity in elderly patients with allergic rhinitis

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