Development and validation of a prediction model for moxifloxacin-induced delirium in patients with community-acquired pneumonia: a retrospective cross-sectional study

Development and validation of a prediction model for moxifloxacin-induced delirium in patients with community-acquired pneumonia: a retrospective cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development and validation of a prediction model for moxifloxacin-induced delirium in patients with community-acquired pneumonia: a retrospective cross-sectional study Peng Xue, Peishan Li, Ling Lin, Zhengting Deng, Xiaohu Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4725458/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The problem of delirium caused by fluoroquinolones, especially moxifloxacin, has posed a great challenge to clinical practice. Currently, there is a shortage of predictive models for predicting moxifloxacin-induced delirium. Therefore, this study aims to develop and validate a predictive model for moxifloxacin-induced delirium in community-acquired pneumonia (CAP) patients. Methods This retrospective cross-sectional study was conducted in Taizhou, Jiangsu Province, China. A total of 488 CAP patients who had received moxifloxacin treatment were included between June 2023 and March 2024. Least absolute shrinkage and selection operator (LASSO) regression and multiple logistic regression were used to identify predictive factors for moxifloxacin-induced delirium. A nomogram containing four predictive factors was created. Discrimination, calibration, and clinical utility were employed to evaluate the model's performance, with internal validation using the bootstrap method. Feasibility analysis of the model was conducted based on the respective prediction probabilities and nomogram scores. Results Among the 488 patients, 9.63% (47/488) exhibited moxifloxacin-induced delirium, while the remaining 90.37% (401/488) did not encounter such adverse effects. Through LASSO and multiple logistic regression analysis, we identified increasing age, weight loss, elevated bilirubin levels, and a history of ischemic heart disease as significant predictive factors. These four predictors were utilized to construct a predictive nomogram. The area under the receiver operating characteristic curve (AUC) was determined to be 0.889 (95% CI 0.841–0.937), which was further validated through bootstrap sampling analysis with an AUC of 0.897 (95% CI 0.846–0.949). The Hosmer-Lemeshow test yielded a p-value of 0.257, and the calibration curve also indicated that the model exhibits good calibration ability. The decision curve analysis (DCA) demonstrated a positive net benefit within a risk range from 0.5–77%. The clinical impact curve demonstrated a strong alignment between the model's predictions and actual occurrences when the risk threshold exceeded 0.3. The feasibility analysis not only demonstrated the model's advantages over internal variables but also revealed significantly elevated nomogram scores in delirium patients. Conclusions This study has developed a predictive model for identifying moxifloxacin-induced delirium in CAP patients, exhibiting excellent performance and providing valuable assistance to clinicians in identifying high-risk individuals. Moxifloxacin Nomogram Delirium Predictive model LASSO Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4725458","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":335741731,"identity":"a937a06a-1262-4d78-928e-0b884e8fb622","order_by":0,"name":"Peng Xue","email":"","orcid":"","institution":"Taizhou Affiliated Hospital of Nanjing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Peng","middleName":"","lastName":"Xue","suffix":""},{"id":335741732,"identity":"396998d9-8e59-43a9-a050-fd12c2e7c6de","order_by":1,"name":"Peishan Li","email":"","orcid":"","institution":"Nanjing Brain Hospital","correspondingAuthor":false,"prefix":"","firstName":"Peishan","middleName":"","lastName":"Li","suffix":""},{"id":335741733,"identity":"100123d5-b01f-4d6e-9c00-a95f91010be2","order_by":2,"name":"Ling Lin","email":"","orcid":"","institution":"Taizhou Affiliated Hospital of Nanjing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ling","middleName":"","lastName":"Lin","suffix":""},{"id":335741736,"identity":"a77f2263-06a5-474d-8578-de52fe0425b3","order_by":3,"name":"Zhengting Deng","email":"","orcid":"","institution":"Taizhou Affiliated Hospital of Nanjing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Zhengting","middleName":"","lastName":"Deng","suffix":""},{"id":335741737,"identity":"29e1457a-396c-4d90-9a88-b140d8098236","order_by":4,"name":"Xiaohu Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYDACCSBmbGCGcD4Y2MiRoIUNSM8oSDMmTQszz4fDiQR18M9uPvaYd4e1HP/85mOfbQyYExjYDx/dgNeSO8fSDWeeSTeWOMaWPDvHgC2PgSct7QY+LQYSOWYSH9sOJ25g4zFmzjHgKWaQ4DEjoCX/m0QiTIuFgURiA2EtOWwIWxgMDAhrkbiRZiY5sw3kl7Rkxh6DBGM2Qn7hn5H8TJq3DRhizYcPM/z481+On/3wMbxaMAEbacpHwSgYBaNgFGADAJ+QQbxU36/xAAAAAElFTkSuQmCC","orcid":"","institution":"Nanjing University of Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Xiaohu","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2024-07-11 16:21:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4725458/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4725458/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72128575,"identity":"b0d83c53-afd5-446b-b083-091a6e51f887","added_by":"auto","created_at":"2024-12-23 03:38:40","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":788484,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4725458/v1_covered_b5b20ea9-bbfc-4625-940a-2444372547cc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development and validation of a prediction model for moxifloxacin-induced delirium in patients with community-acquired pneumonia: a retrospective cross-sectional study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Moxifloxacin, Nomogram, Delirium, Predictive model, LASSO","lastPublishedDoi":"10.21203/rs.3.rs-4725458/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4725458/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe problem of delirium caused by fluoroquinolones, especially moxifloxacin, has posed a great challenge to clinical practice. Currently, there is a shortage of predictive models for predicting moxifloxacin-induced delirium. Therefore, this study aims to develop and validate a predictive model for moxifloxacin-induced delirium in community-acquired pneumonia (CAP) patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective cross-sectional study was conducted in Taizhou, Jiangsu Province, China. A total of 488 CAP patients who had received moxifloxacin treatment were included between June 2023 and March 2024. Least absolute shrinkage and selection operator (LASSO) regression and multiple logistic regression were used to identify predictive factors for moxifloxacin-induced delirium. A nomogram containing four predictive factors was created. Discrimination, calibration, and clinical utility were employed to evaluate the model's performance, with internal validation using the bootstrap method. Feasibility analysis of the model was conducted based on the respective prediction probabilities and nomogram scores.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong the 488 patients, 9.63% (47/488) exhibited moxifloxacin-induced delirium, while the remaining 90.37% (401/488) did not encounter such adverse effects. Through LASSO and multiple logistic regression analysis, we identified increasing age, weight loss, elevated bilirubin levels, and a history of ischemic heart disease as significant predictive factors. These four predictors were utilized to construct a predictive nomogram. The area under the receiver operating characteristic curve (AUC) was determined to be 0.889 (95% CI 0.841\u0026ndash;0.937), which was further validated through bootstrap sampling analysis with an AUC of 0.897 (95% CI 0.846\u0026ndash;0.949). The Hosmer-Lemeshow test yielded a p-value of 0.257, and the calibration curve also indicated that the model exhibits good calibration ability. The decision curve analysis (DCA) demonstrated a positive net benefit within a risk range from 0.5\u0026ndash;77%. The clinical impact curve demonstrated a strong alignment between the model's predictions and actual occurrences when the risk threshold exceeded 0.3. The feasibility analysis not only demonstrated the model's advantages over internal variables but also revealed significantly elevated nomogram scores in delirium patients.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study has developed a predictive model for identifying moxifloxacin-induced delirium in CAP patients, exhibiting excellent performance and providing valuable assistance to clinicians in identifying high-risk individuals.\u003c/p\u003e","manuscriptTitle":"Development and validation of a prediction model for moxifloxacin-induced delirium in patients with community-acquired pneumonia: a retrospective cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-06 15:58:32","doi":"10.21203/rs.3.rs-4725458/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8d545e51-0870-4f4d-9ff5-a30418d576c4","owner":[],"postedDate":"August 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-23T03:38:23+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-06 15:58:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4725458","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4725458","identity":"rs-4725458","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}