慢性阻塞性肺疾病急性加重期患者出院30天内再入院风险预测模型的构建
Construction of a 30-day readmission risk prediction model for patients with AECOPD after hospital discharge
陈清清 1谢菊艳 2黄赣英2
作者信息
- 1. 浙江中医药大学 第四临床医学院,浙江 杭州 310053;杭州市第一人民医院 急诊科,浙江 杭州 310006
- 2. 杭州市第一人民医院 急诊科,浙江 杭州 310006
- 折叠
摘要
目的 探讨慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECO-PD)患者出院 30 天内再入院的相关危险因素,并构建其风险预测模型,为临床早期识别再入院高风险人群并进行精准干预提供参考.方法 回顾性选取 241 例AECOPD患者为研究对象,依据患者 30 天内是否再入院分为再入院组(33 例)和未再入院组(208 例).通过单因素及多因素Logistic回归分析AECOPD患者再入院的影响因素,应用R软件建立AECOPD患者30 天内再入院发生风险的列线图模型;并绘制校准曲线图.结果 年龄>75 岁(OR=4.531,95%CI:1.856～8.920)、合并冠心病(OR=3.079,95%CI:1.291～6.378)、营养不良(OR=4.318,95%CI:1.371～8.245)、过去一年急性加重次数≥2 次(OR=5.102,95%CI:2.050～10.726)、日活动时间<30 min(OR=3.185,95%CI:1.332～7.163)、FEV1%Pred<50%(OR=2.810,95%CI:1.208～4.055),是AECOPD患者出院 30天内再入院的独立危险因素.以此建立 AECOPD 患者出院 30 天内再入院的列线图模型,模型曲线下面积(AUC)为 0.926(95%CI:0.900～0.952),灵敏度为 86.3%,特异度为 84.9%.经Bootstrap校准后的C-index为0.921.结论 AECOPD患者出院 30 天内再入院与高龄、合并冠心病、FEV1 下降、缺少体育锻炼、营养不良及既往频繁急性加重史有关,以此构建的预测模型可以科学、直观、简便地识别存在短期再入院风险的AECOPD患者.
Abstract
Objective To investigate the relevant risk factors for hospital readmission within 30 days after discharge in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and to construct a risk prediction model,providing reference for early clinical identification of high-risk groups for readmission and to facilitate precise interventions.Methods A retrospective study was conducted,in which 241 patients with AECOPD were selected as the research subjects and divided into readmission group(33 cases)and non-readmission group(208 cases)based on whether they were readmitted within 30 days.Univariate and multivariate Logistic regression analyses were performed to identify the influencing factors for readmission of AECOPD patients.The R software was applied to establish a nomogram model for the risk of readmission within 30 days for AECOPD patients,and a calibration curve was plotted.Results Age>75 years(OR=4.531,95%CI:1.856～8.920),comorbidity with coronary heart disease(OR=3.079,95%CI:1.291～6.378),malnutrition(OR=4.318,95%CI:1.371～8.245),≥2 acute exacerbations in the past year(OR=5.102,95%CI:2.050～10.726),daily activity duration<30 minutes(OR=3.185,95%CI:1.332～7.163),and FEV1%predicted<50%(OR=2.810,95%CI:1.208～4.055)were identified as independent risk factors for readmission within 30 days of discharge in AECOPD patients.A nomogram model was constructed for readmission within 30 days was established based on these factors,with an area under the curve(AUC)of 0.926(95%CI:0.900～0.952),sensitivity of 86.3%,and specificity of 84.9%.The C-index after Bootstrap calibration was 0.921.Conclusions Hospital readmission within 30 days of discharge for AECOPD patients is associated with advanced age,comorbid coronary heart disease,decreased FEV1,lack of physical activity,malnutrition,and a history of frequent exacerbations.The predictive model constructed based on these factors can scientifically,intuitively,and conveniently identify AECOPD patients at risk of short-term readmission.
关键词
慢性阻塞性肺疾病/急性加重期/出院30天内再入院/危险因素/风险评估Key words
chronic obstructive pulmonary disease/acute exacerbation phase/readmission within 30 days after discharge/risk factors/risk assessment引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
万方数据