{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:28:55Z","timestamp":1760056135790,"version":"build-2065373602"},"reference-count":53,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Sichuan Provincial Administration of Traditional Chinese Medicine Research Fund","award":["2020JC0079"],"award-info":[{"award-number":["2020JC0079"]}]},{"name":"Sichuan Provincial Department of Science and Technology Research Special Fund","award":["2021YFS0259"],"award-info":[{"award-number":["2021YFS0259"]}]},{"name":"Nanchong Science and Technology Plan Project","award":["22JCYJPT0005","22JCYJPT0011"],"award-info":[{"award-number":["22JCYJPT0005","22JCYJPT0011"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n               <jats:title>Background<\/jats:title>\n               <jats:p>Patients receiving maintenance hemodialysis (MHD) who develop pneumonia experience substantially elevated risks of hospitalization and mortality, while also incurring significantly heightened healthcare-related financial burdens. Our goal is to establish a forecasting model to assess the individual risk of pneumonia in patients undergoing MHD.<\/jats:p>\n            <\/jats:sec>\n            <jats:sec>\n               <jats:title>Materials and Methods<\/jats:title>\n               <jats:p>A retrospective analysis was carried out between January 2018 and November 2024, involving 405 MHD patients from two medical centers. The variables underwent adjustment through multivariate Cox regression analysis, and the forecasting model was created and verified.<\/jats:p>\n            <\/jats:sec>\n            <jats:sec>\n               <jats:title>Results<\/jats:title>\n               <jats:p>The median follow-up time of the external validation set was 35 months (interquartile range: 20\u201343), and the median follow-up time of the modeling set was 22 months (12\u201324). The event happened in 101 (34.83%) out of 290 patients in the modeling set and 45 (39.13%) out of 115 patients in the external validation set. The model predictors included history of diabetes and coronary heart disease; serous effusion; white blood cell; albumin-globulin ratio; left ventricular mass index, and age. The C-index was 0.753 (0.684, 0.822) for the external validation set and 0.772 (95% CI [0.724\u20130.821]) for the modeling set. The model showed excellent calibration ability throughout the risk spectrum, and decision curve analysis showed that it could maximize the prognosis of patients.<\/jats:p>\n            <\/jats:sec>\n            <jats:sec>\n               <jats:title>Conclusion<\/jats:title>\n               <jats:p>The created predictive model provided a precise, individualized evaluation of pneumonia risk in patients with MHD. It can be used to identify individuals at high risk of pulmonary infection in patients undergoing MHD and guide their treatment and prognosis follow-up.<\/jats:p>\n            <\/jats:sec>","DOI":"10.7717\/peerj.20070","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T08:22:51Z","timestamp":1759998171000},"page":"e20070","source":"Crossref","is-referenced-by-count":0,"title":["Development and external validation of a multivariate model for predicting pneumonia in patients receiving maintenance hemodialysis: a retrospective study"],"prefix":"10.7717","volume":"13","author":[{"given":"Xiao Hua","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Nephrology, Guangyuan Central Hospital, Guangyuan City, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ju","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Guangyuan Central Hospital, Guangyuan City, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xi Sheng","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Nanchong Central Hospital Affiliated to North Sichuan Medical College,  Nanchong City, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen Wu","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Guangyuan Central Hospital, Guangyuan City, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4443","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"10.7717\/peerj.20070\/ref-1","doi-asserted-by":"publisher","first-page":"97","DOI":"10.3393\/ac.2021.01004.0143","article-title":"Pretreatment inflammatory markers predicting treatment outcomes in colorectal cancer","volume":"38","author":"An","year":"2022","journal-title":"Annals of Coloproctology"},{"key":"10.7717\/peerj.20070\/ref-2","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1038\/s42255-020-0178-9","article-title":"Type 2 diabetes influences bacterial tissue compartmentalisation in human obesity","volume":"2","author":"Anh\u00ea","year":"2020","journal-title":"Nature Metabolism"},{"key":"10.7717\/peerj.20070\/ref-3","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1016\/s0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"396","year":"2020","journal-title":"Lancet"},{"key":"10.7717\/peerj.20070\/ref-4","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1097\/hco.0000000000000604","article-title":"Cardiovascular complications following pneumonia: focus on pneumococcus and heart failure","volume":"34","author":"Bartlett","year":"2019","journal-title":"Current Opinion in Cardiology"},{"key":"10.7717\/peerj.20070\/ref-5","doi-asserted-by":"publisher","first-page":"8923","DOI":"10.1038\/s41598-023-35353-8","article-title":"The prognostic value of URR equals that of Kt\/V for all-cause mortality in Taiwan after 10-year follow-up","volume":"13","author":"Chen","year":"2023","journal-title":"Scientific Reports"},{"key":"10.7717\/peerj.20070\/ref-6","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1016\/s0140-6736(12)61266-5","article-title":"Acute pneumonia and the cardiovascular system","volume":"381","author":"Corrales-Medina","year":"2013","journal-title":"Lancet"},{"key":"10.7717\/peerj.20070\/ref-7","doi-asserted-by":"publisher","first-page":"2127","DOI":"10.2337\/dc18-0287","article-title":"Glycemic control and risk of infections among people with type 1 or type 2 diabetes in a large primary care cohort study","volume":"41","author":"Critchley","year":"2018","journal-title":"Diabetes Care"},{"key":"10.7717\/peerj.20070\/ref-8","doi-asserted-by":"publisher","first-page":"2391","DOI":"10.1007\/s11255-024-03953-6","article-title":"Predicting the risk of pulmonary infection in patients with chronic kidney failure: A-C(2)GH(2)S risk score\u2014a retrospective study","volume":"56","author":"Deng","year":"2024","journal-title":"International Urology and Nephrology"},{"key":"10.7717\/peerj.20070\/ref-9","doi-asserted-by":"publisher","first-page":"1482","DOI":"10.1093\/cid\/ciy723","article-title":"Prevalence and etiology of community-acquired pneumonia in immunocompromised patients","volume":"68","author":"Di\u00a0Pasquale","year":"2019","journal-title":"Clinical Infectious Diseases"},{"key":"10.7717\/peerj.20070\/ref-10","doi-asserted-by":"publisher","first-page":"1426","DOI":"10.12669\/pjms.38.6.4834","article-title":"Clinical characteristics of catheter-related infection in patients with chronic renal failure end stage renal failure undergoing semi-permanent catheter placement during maintenance hemodialysis through tunnelled cuffed hemodialysis catheter","volume":"38","author":"Dou","year":"2022","journal-title":"Pakistan Journal of Medical Sciences"},{"key":"10.7717\/peerj.20070\/ref-11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/toxins12040227","article-title":"Inflammation and premature ageing in chronic kidney disease","volume":"12","author":"Ebert","year":"2020","journal-title":"Toxins"},{"key":"10.7717\/peerj.20070\/ref-12","doi-asserted-by":"publisher","first-page":"e0119671","DOI":"10.1371\/journal.pone.0119671","article-title":"Survival nomogram for curatively resected Korean gastric cancer patients: multicenter retrospective analysis with external validation","volume":"10","author":"Eom","year":"2015","journal-title":"PLOS ONE"},{"key":"10.7717\/peerj.20070\/ref-13","doi-asserted-by":"publisher","first-page":"101044","DOI":"10.1016\/j.molmet.2020.101044","article-title":"Diabetes, infection risk and COVID-19","volume":"39","author":"Erener","year":"2020","journal-title":"Molecular Metabolism"},{"key":"10.7717\/peerj.20070\/ref-14","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1136\/archdischild-2014-307654","article-title":"Chronic comorbidities in children with type 1 diabetes: a population-based cohort study","volume":"100","author":"Fazeli\u00a0Farsani","year":"2015","journal-title":"Archives of Disease in Childhood"},{"key":"10.7717\/peerj.20070\/ref-15","doi-asserted-by":"publisher","first-page":"996","DOI":"10.34067\/kid.0001282021","article-title":"SARS-CoV-2 infection risk factors among maintenance hemodialysis patients and health care personnel in outpatient hemodialysis centers","volume":"2","author":"Gandra","year":"2021","journal-title":"Kidney360"},{"key":"10.7717\/peerj.20070\/ref-16","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.rmed.2019.07.007","article-title":"Predicting the need for ICU admission in community-acquired pneumonia","volume":"155","author":"Gearhart","year":"2019","journal-title":"Respiratory Medicine"},{"key":"10.7717\/peerj.20070\/ref-17","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1093\/ndt\/gfm474","article-title":"Pneumonia in incident dialysis patients\u2014the United States renal data system","volume":"23","author":"Guo","year":"2008","journal-title":"Nephrology, Dialysis, Transplantation"},{"key":"10.7717\/peerj.20070\/ref-18","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-19425-7","volume-title":"Regression modeling strategies. With applications to linear models, logistic and ordinal regression, and survival analysis","author":"Harrell","year":"2015"},{"key":"10.7717\/peerj.20070\/ref-19","doi-asserted-by":"publisher","first-page":"e895-e1032","DOI":"10.1161\/cir.0000000000001063","article-title":"2022 AHA\/ACC\/HFSA guideline for the management of heart failure: a report of the American College of Cardiology\/American Heart Association Joint Committee on clinical practice guidelines","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"key":"10.7717\/peerj.20070\/ref-20","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1186\/s12931-024-02874-3","article-title":"An explainable machine learning-based model to predict intensive care unit admission among patients with community-acquired pneumonia and connective tissue disease","volume":"25","author":"Huang","year":"2024","journal-title":"Respiratory Research"},{"key":"10.7717\/peerj.20070\/ref-21","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1007\/s10741-023-10376-5","article-title":"Echocardiographic manifestations in end-stage renal disease","volume":"29","author":"Ito","year":"2024","journal-title":"Heart Failure Reviews"},{"key":"10.7717\/peerj.20070\/ref-22","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1177\/2048872617700874","article-title":"Pneumonia and inflammation in acute decompensated heart failure: a registry-based analysis of 1939 patients","volume":"7","author":"Jobs","year":"2018","journal-title":"European Heart Journal. Acute Cardiovascular Care"},{"key":"10.7717\/peerj.20070\/ref-23","doi-asserted-by":"publisher","first-page":"1581","DOI":"10.3390\/cells12121581","article-title":"The role of inflammation in CKD","volume":"12","author":"Kadatane","year":"2023","journal-title":"Cell"},{"key":"10.7717\/peerj.20070\/ref-24","doi-asserted-by":"publisher","first-page":"9696","DOI":"10.1038\/s41598-021-89038-1","article-title":"Hospitalization for acute coronary syndrome increases the long-term risk of pneumonia: a population-based cohort study","volume":"11","author":"Kim","year":"2021","journal-title":"Scientific Reports"},{"key":"10.7717\/peerj.20070\/ref-25","doi-asserted-by":"publisher","first-page":"343","DOI":"10.2215\/cjn.11941017","article-title":"Re-evaluation of the normal range of serum total CO(2) concentration","volume":"13","author":"Kraut","year":"2018","journal-title":"Clinical Journal of the American Society of Nephrology"},{"key":"10.7717\/peerj.20070\/ref-26","doi-asserted-by":"publisher","first-page":"01","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of cardiovascular imaging","volume":"28","author":"Lang","year":"2015","journal-title":"Journal of the American Society of Echocardiography"},{"key":"10.7717\/peerj.20070\/ref-27","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1053\/j.jrn.2022.01.008","article-title":"Nutritional disorder evaluated by the geriatric nutritional risk index predicts death after hospitalization for infection in patients undergoing maintenance hemodialysis","volume":"32","author":"Machiba","year":"2022","journal-title":"Journal of Renal Nutrition"},{"key":"10.7717\/peerj.20070\/ref-28","doi-asserted-by":"publisher","first-page":"1974","DOI":"10.1016\/j.jacc.2021.03.010","article-title":"Impact of pneumonia in heart failure patients","volume":"77","author":"Mancini","year":"2021","journal-title":"Journal of the American College of Cardiology"},{"key":"10.7717\/peerj.20070\/ref-29","doi-asserted-by":"publisher","first-page":"e240830","DOI":"10.1001\/jamanetworkopen.2024.0830","article-title":"Diagnostic stewardship in community-acquired pneumonia with syndromic molecular testing: a randomized clinical trial","volume":"7","author":"Markussen","year":"2024","journal-title":"JAMA Network Open"},{"key":"10.7717\/peerj.20070\/ref-30","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1681\/asn.2021091262","article-title":"Vaccine effectiveness against SARS-CoV-2 infection and severe outcomes in the maintenance dialysis population in Ontario, Canada","volume":"33","author":"Oliver","year":"2022","journal-title":"Journal of the American Society of Nephrology"},{"key":"10.7717\/peerj.20070\/ref-31","doi-asserted-by":"publisher","first-page":"S241","DOI":"10.1093\/infdis\/jiaa702","article-title":"The lung microbiome and pneumonia","volume":"223","author":"Pettigrew","year":"2021","journal-title":"Journal of Infectious Diseases"},{"key":"10.7717\/peerj.20070\/ref-32","doi-asserted-by":"publisher","first-page":"1896","DOI":"10.1016\/j.chest.2020.05.598","article-title":"Treatment of community-acquired pneumonia in immunocompromised adults: a consensus statement regarding initial strategies","volume":"158","author":"Ramirez","year":"2020","journal-title":"Chest"},{"key":"10.7717\/peerj.20070\/ref-33","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/ijms231911501","article-title":"Prognostic value of albumin to globulin ratio in non-metastatic and metastatic prostate cancer patients: a meta-analysis and systematic review","volume":"23","author":"Salciccia","year":"2022","journal-title":"International Journal of Molecular Sciences"},{"key":"10.7717\/peerj.20070\/ref-34","doi-asserted-by":"publisher","first-page":"5512","DOI":"10.1002\/sim.3148","article-title":"Selection of important variables and determination of functional form for continuous predictors in multivariable model building","volume":"26","author":"Sauerbrei","year":"2007","journal-title":"Statistics in Medicine"},{"key":"10.7717\/peerj.20070\/ref-35","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1186\/s13063-022-06467-7","article-title":"Impact of rapid molecular testing on diagnosis, treatment and management of community-acquired pneumonia in Norway: a pragmatic randomised controlled trial (CAPNOR)","volume":"23","author":"Serigstad","year":"2022","journal-title":"Trials"},{"key":"10.7717\/peerj.20070\/ref-36","doi-asserted-by":"publisher","first-page":"1961","DOI":"10.1016\/j.jacc.2021.03.001","article-title":"Incidence and outcomes of pneumonia in patients with heart failure","volume":"77","author":"Shen","year":"2021","journal-title":"Journal of the American College of Cardiology"},{"key":"10.7717\/peerj.20070\/ref-37","doi-asserted-by":"publisher","first-page":"23878","DOI":"10.1038\/s41598-021-03440-3","article-title":"Development and validation of a new scoring system for prognostic prediction of community-acquired pneumonia in older adults","volume":"11","author":"Shirata","year":"2021","journal-title":"Scientific Reports"},{"key":"10.7717\/peerj.20070\/ref-38","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.1038\/sj.ki.5001714","article-title":"Clinical epidemiology of pneumonia in hemodialysis patients: the USRDS waves 1 3, and 4 study","volume":"70","author":"Slinin","year":"2006","journal-title":"Kidney International"},{"key":"10.7717\/peerj.20070\/ref-39","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1002\/jpen.1451","article-title":"Hypoalbuminemia: pathogenesis and clinical significance","volume":"43","author":"Soeters","year":"2019","journal-title":"Journal of Parenteral and Enteral Nutrition"},{"key":"10.7717\/peerj.20070\/ref-40","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1111\/1744-9987.13507","article-title":"Seroepidemiology of hepatitis E virus infection in patients undergoing maintenance hemodialysis: systematic review and meta-analysis","volume":"25","author":"Tavakoli","year":"2021","journal-title":"Therapeutic Apheresis and Dialysis"},{"key":"10.7717\/peerj.20070\/ref-41","doi-asserted-by":"publisher","first-page":"1376","DOI":"10.1126\/science.aar3318","article-title":"Hyperglycemia drives intestinal barrier dysfunction and risk for enteric infection","volume":"359","author":"Thaiss","year":"2018","journal-title":"Science"},{"key":"10.7717\/peerj.20070\/ref-42","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1111\/1744-9987.13569","article-title":"Incidence of shunt infection among patients on maintenance dialysis with buttonhole technique: Okinawa hemodialysis survey","volume":"25","author":"Toma","year":"2021","journal-title":"Therapeutic Apheresis and Dialysis"},{"key":"10.7717\/peerj.20070\/ref-43","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1038\/s41572-021-00259-0","article-title":"Pneumonia","volume":"7","author":"Torres","year":"2021","journal-title":"Nature Reviews Disease Primers"},{"key":"10.7717\/peerj.20070\/ref-44","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9020414","article-title":"Cardiovascular events after community-acquired pneumonia: a global perspective with systematic review and meta-analysis of observational studies","volume":"9","author":"Tralh\u00e3o","year":"2020","journal-title":"Journal of Clinical Medicine"},{"key":"10.7717\/peerj.20070\/ref-45","first-page":"S91","article-title":"Polymorphonuclear cell function and infection in dialysis","volume":"38","author":"Vanholder","year":"1992","journal-title":"Kidney International. Supplement"},{"key":"10.7717\/peerj.20070\/ref-46","doi-asserted-by":"publisher","first-page":"1541","DOI":"10.1681\/asn.V391541","article-title":"Infectious morbidity and defects of phagocytic function in end-stage renal disease: a review","volume":"3","author":"Vanholder","year":"1993","journal-title":"Journal of the American Society of Nephrology"},{"key":"10.7717\/peerj.20070\/ref-47","doi-asserted-by":"publisher","first-page":"1282","DOI":"10.1001\/jama.2024.14796","article-title":"Community-acquired pneumonia: a review","volume":"332","author":"Vaughn","year":"2024","journal-title":"Journal of the American Medical Association"},{"key":"10.7717\/peerj.20070\/ref-48","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1177\/0272989x06295361","article-title":"Decision curve analysis: a novel method for evaluating prediction models","volume":"26","author":"Vickers","year":"2006","journal-title":"Medical Decision Making"},{"key":"10.7717\/peerj.20070\/ref-49","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1016\/j.phrs.2018.10.008","article-title":"Relationship between diabetes and respiratory diseases\u2014clinical and therapeutic aspects","volume":"137","author":"Visca","year":"2018","journal-title":"Pharmacological Research"},{"key":"10.7717\/peerj.20070\/ref-50","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1053\/j.ajkd.2021.06.015","article-title":"Outcomes from infections with variant strains of SARS-CoV-2 among patients receiving maintenance hemodialysis","volume":"78","author":"Wand","year":"2021","journal-title":"American Journal of Kidney Diseases"},{"key":"10.7717\/peerj.20070\/ref-51","doi-asserted-by":"publisher","first-page":"1479","DOI":"10.1007\/s40620-022-01245-9","article-title":"Humoral response and breakthrough infections with SARS-CoV-2 B.1.617.2 variant in vaccinated maintenance hemodialysis patients","volume":"35","author":"Wand","year":"2022","journal-title":"Journal of Nephrology"},{"key":"10.7717\/peerj.20070\/ref-52","doi-asserted-by":"publisher","first-page":"1403","DOI":"10.1093\/cid\/ciae044","article-title":"Development of patient safety measures to identify inappropriate diagnosis of common infections","volume":"78","author":"White","year":"2024","journal-title":"Clinical Infectious Diseases"},{"key":"10.7717\/peerj.20070\/ref-53","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1038\/nrneph.2017.52","article-title":"The systemic nature of CKD","volume":"13","author":"Zoccali","year":"2017","journal-title":"Nature Reviews Nephrology"}],"container-title":["PeerJ"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/peerj.com\/articles\/20070.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/20070.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/20070.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/20070.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T08:22:57Z","timestamp":1759998177000},"score":1,"resource":{"primary":{"URL":"https:\/\/peerj.com\/articles\/20070"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,9]]},"references-count":53,"alternative-id":["10.7717\/peerj.20070"],"URL":"https:\/\/doi.org\/10.7717\/peerj.20070","archive":["CLOCKSS","LOCKSS","Portico"],"relation":{},"ISSN":["2167-8359"],"issn-type":[{"value":"2167-8359","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,9]]},"article-number":"e20070"}}