Predictive value of the Geriatric Nutritional Risk Index for 30-day readmission in patients with Acute Exacerbation of COPD
Objective To explore the predictive value of the Geriatric Nutritional Risk Index(GNRI)for 30-day readmission in pa-tients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods The clinical data of 324 AECOPD pa-tients were retrospectively collected.According to whether they were readmitted within 30 days of discharge,they were divided in-to 269 cases in the non-readmission group and 55 cases in the readmission group,and the clinical data of the two groups were com-pared.The influencing factors of 30-day readmission in AECOPD patients were analyzed by using logistic regression analysis.ROC curves were used to analyze the assessed value of 30-day readmission by GNRI alone as well as after calibrating the confounders.The practical value of predicting 30-day readmission was analyzed by Decision Curve Analysis(DCA)by GNRI alone as well as af-ter calibrating the confounders.Results The percentage of long-term oxygen therapy,CAT score,WBC,and erythrocyte sedimen-tation rate were significantly higher in the readmission group than those in the non-readmission group,and its FEV1％pred,PaO2,and GNRI were significantly lower than those in the non-readmission group(all P＜0.05).Quartiles of GNRI divided the patients into 4 groups,the readmission rates in GNRI Q4,Q3,Q2,and Q1 group were 4.94％(4/81),6.17％(5/81),23.46％(19/81)and 33.33％(27/81),and the difference was statistically significant(P＜0.05).Logistic regression analysis showed that,long-term oxygen therapy,FEV1％pred,CAT score,and GNRI were the influencing factors for 30-day readmission in AECOPD pa-tients(all P＜0.05).Before and after calibrating for confounders of age,gender,long-term oxygen therapy,CAT score,and FEV1％pred,the risk of readmission was significantly lower in those with GNRI Q3 and Q4(all P＜0.05),and the OR value showed a decreasing trend(P trend＜0.05).The AUC of GNRI alone predicting 30-day readmission in AECOPD patients was 0.819(95％CI:0.773-0.860),and the AUC after calibrating for confounders was 0.858(95％CI:0.815-0.894),and the diffe-rence between the AUCs before and after calibrating was not statistically significant(P＞0.05).The net benefit of GNRI alone in predicting 30-day readmission was 0.04-0.61,which was 0.05-0.70 after calibrating for confounders.Conclusion GNRI is an in-dependent influencing factor of 30-day readmission in AECOPD patients,and it can effectively predict their occurrence of 30-day readmission.
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