老年AECOPD患者全因再入院的影响因素及其风险预测列线图模型构建OA

Objective To investigate the influencing factors of all-cause readmission in elderly patients with AECOPD,and construct its risk prediction nomogram model.Methods Clinical data of 887 elderly AECOPD patients admitted to Department of Respiratory Medicine in the Dongzhimen Hospital,Beijing University of Chinese Medicine from 2013 to 2019 were selected.Patients were divided into the readmission group(n=572)and the non-readmission group(n=315)according to the occurrence of all-cause readmission.LASSO regression analysis and multivariate Logistic regression analysis were used to explore the influencing factors for all-cause readmission in elderly patients with AECOPD.The risk prediction nomogram model was constructed by using R 4.2.1 software,and Hosmer-Lemeshow goodness-of-fit test,calibration curve,and ROC curve were used to evaluate the fitting degree,calibration degree,and discrimination degree of the model.Results The hospitalization rate for AECOPD in the 1 year before admission,proportion of patients using ventilator,proportion of patients with length of hospital stay>7 d,as well as proportions of patients with coronary heart disease,hyperuricemia,congestive heart failure,pulmonary heart disease,respiratory failure,cataract in the readmission group were higher than those in the non-readmission group,Activities of Daily Living(ADL)Scale score at admission,ADL Scale score at discharge,proportion of patients with non-alcoholic fatty liver disease,proportion of patients with Charlson Comorbidity Index(CCI)≤2 were lower than those in the non-readmission group(P<0.05).Multivariate Logistic regression analysis results showed that hospitalization for AECOPD in the 1 year before admission,length of hospital stay,coronary heart disease,hyperuricemia,non-alcoholic fatty liver disease,cataract were independent influencing factors for all-cause readmission in elderly patients with AECOPD(P<0.05).The nomogram model for predicting the risk of all-cause readmission in elderly patients with AECOPD was constructed according to these factors.The Hosmer-Lemeshow goodness-of-fit test results showed that the nomogram model fitted well(χ2=2.036,P=0.916).The calibration curve results showed that the predicted probability was consistent with the actual probability.The ROC curve analysis results showed that the AUC of the model for predicting all-cause readmission in elderly patients with AECOPD was 0.657[95%CI(0.620-0.694)].Conclusion Hospitalization for AECOPD in the 1 year before admission,length of hospital stay,coronary heart disease,hyperuricemia,non-alcoholic fatty liver disease,cataract are independent influencing factors for all-cause readmission in elderly patients with AECOPD.The risk prediction nomogram model of all-cause readmission in elderly patients with AECOPD constructed based on the above factors has a good calibration degree,and a certain discrimination.