老年慢性阻塞性肺疾病患者30天内急性加重再入院风险预测模型的构建与验证  

Construction and validation of a predictive model of acute exacerbation readmission risk within 30 days in elderly patients with chronic obstructive pulmonary disease

作　　者：张瑞 吴珍珍[1,3] 常艳 芦鸿雁 ZHANG Rui;WU Zhenzhen;CHANG Yan;LU Hongyan(School of Nursing,Ningxia Medical University,Yinchuan,Ningxia 750004,P.R.China;Department of Nursing,General Hospital ofNingxia Medical University,Yinchuan,Ningxia 750004,P.R.China)

机构地区：[1]宁夏医科大学护理学院,宁夏银川750004 [2]宁夏医科大学总医院护理部,宁夏银川750004 [3]宁夏医科大学总医院

出　　处：《中国呼吸与危重监护杂志》2021年第7期457-464,共8页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：2018年宁夏回族自治区科技厅惠民项目(2018CMG03009);宁夏回族自治区重点研发计划项目。

摘　　要：目的分析老年慢性阻塞性肺疾病(简称慢阻肺)患者30天内急性加重再入院的影响因素,构建并验证风险预测模型。方法采用便利抽样法,选取2019年4月至2020年8月宁夏地区13所综合医院呼吸内科1 120例老年慢阻肺患者作为研究对象,并随访至出院后30天。按问卷填写时间先进入研究的784例患者作为建模组,后进入研究的336例作为验证组,对模型预测效果进行验证。结果文化程度、吸烟情况、过去1年慢阻肺急性加重住院次数、是否规律用药、是否康复锻炼、营养状况及季节因素是患者再入院的影响因素。由此建立风险预测模型公式:Z=–8.225–0.310×文化程度赋值+0.564×吸烟情况赋值+0.873×过去1年急性加重住院次数的赋值+0.779×规律用药的赋值+0.617×康复锻炼的赋值+0.970×营养状况的赋值+季节因素[1.170×春季(0,1)+0.793×秋季(0,1)+1.488×冬季(0,1)]。受试者工作特征曲线下面积为0.746,敏感性为75.90%,特异性为64.30%,Hosmer-Lemeshow检验显示P=0.278。模型验证结果:敏感性为69.44%,特异性为85.71%,准确率为81.56%。结论文化程度、吸烟情况、过去1年慢阻肺急性加重住院次数、是否规律用药、是否康复锻炼、营养状况及季节因素是慢阻肺患者再入院的影响因素。据此成功构建再入院的风险预测模型。模型具有良好的预测效果,可为医护人员对高危患者采取预防性治疗和护理措施提供参考依据。Objective To analyze the influencing factors of acute exacerbation readmission in elderly patients with chronic obstructive pulmonary disease(COPD) within 30 days,construct and validate the risk prediction model.Methods A total of 1 120 elderly patients with COPD in the respiratory department of 13 general hospitals in Ningxia from April 2019 to August 2020 were selected by convenience sampling method and followed up until 30 days after discharge.According to the time of filling in the questionnaire,784 patients who entered the study first served as the modeling group,and 336 patients who entered the study later served as the validation group to verify the prediction effect of the model.Results Education level,smoking status,number of acute exacerbations of COPD hospitalizations in the past 1 year,regular use of medication,rehabilitation and exercise,nutritional status and seasonal factors were the influencing factors of patients’ readmission to hospital.The risk prediction model was constructed:Z=–8.225–0.310×assignment of education level+0.564×assignment of smoking status+0.873×assignment of number of acute exacerbations of COPD hospitalizations in the past 1 year+0.779×assignment of regular use of medication+0.617×assignment of rehabilitation and exercise +0.970×assignment of nutritional status+assignment of seasonal factors[1.170×spring(0,1)+0.793×autumn(0,1)+1.488×winter(0,1)].The area under ROC curve was 0.746,the sensitivity was75.90%,and the specificity was 64.30%.Hosmer-Lemeshow test showed that P=0.278.Results of model validation showed that the sensitivity,the specificity and the accuracy were 69.44%,85.71% and 81.56%,respectively.Conclusions Education level,smoking status,number of acute exacerbations of COPD hospitalizations in the past 1 year,regular use of medication,rehabilitation and exercise,nutritional status and seasonal factors are the influencing factors of patients’ readmission to hospital.The risk prediction model is constructed based on these factor.This model has good pr

关 键 词：慢性阻塞性肺疾病 老年 30天内再入院 风险预测模型 

分 类 号：R563.9[医药卫生—呼吸系统]