ArticleTherapeutic advances in respiratory disease
Diagnostic model for COPD patients with nocardia infection: a study based on clinical features and risk factors.
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Abstract
backgroundThe escalating morbidity and mortality of chronic obstructive pulmonary disease (COPD) necessitates improved diagnostic approaches for comorbid infections. COPD patients exhibit heightened susceptibility to opportunistic pathogens like Nocardia species due to compromised airway defenses and frequent glucocorticoid/immuno-suppressant use. Despite its clinical significance, Nocardia infection remains diagnostically challenging due to nonspecific presentations and imaging features.
objectivesTo develop and validate a diagnostic model integrating clinical characteristics and risk factors for COPD complicated by Nocardia infection.
designA retrospective analysis was conducted on clinical data from 586 patients diagnosed with COPD and Nocardia infection, including clinical symptoms, laboratory tests, imaging findings, and treatment outcomes. Patients were screened according to inclusion and exclusion criteria and divided into two groups: COPD with Nocardia infection group (infection group) and COPD-only group (control group).
methodsThis retrospective study analyzed 586 COPD patients (2019-2024), stratified into Nocardia-infected (
resultsIndependent risk factors included hemoptysis (OR = 1.99, 95% CI: 0.76-5.26), lymphocyte count (OR = 6.81, 95% CI: 4.06-11.42), hemoglobin (OR = 1.01, 95% CI: 0.99-1.03), and pulmonary function parameters (FEV₁/FVC ratio OR = 12.47, 95% CI: 1.25-124.16). The model demonstrated excellent discrimination (C-index: 0.895 infected, 0.829 noninfected) and calibration (mean absolute error: 0.127-0.170). ROC analysis revealed AUCs of 0.896 (95% CI: 0.90-0.97) and 0.830 (95% CI: 0.77-0.89) for infected and noninfected groups, respectively.
conclusionThis validated nomogram provides a clinically actionable tool for early Nocardia detection in COPD patients, addressing a critical diagnostic gap. External validation is warranted to confirm generalizability.
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