红细胞分布宽度与白蛋白比值对慢性阻塞性肺疾病急性加重期患者出院后1年内再入院的预测价值  

Predictive Value of Red Blood Cell Distribution Width to Albumin Ratio for Readmission within 1 Year after Discharge of Patients with AECOPD

作　　者：陈明明 昌淑婷 朱磊[2] 郭鸿 刘健 CHEN Mingming;CHANG Shuting;ZHU Lei;GUO Hong;LIU Jian(The First Clinical Medical College of Lanzhou University,Lanzhou,Gansu 730000,China;Department of Critical Care Medicine,The First Hspital of Lanzhou University,Lanzhou,Gansu 730000,China;Department of Critical Care Medicine,Gansu Provincial Maternity and Child-care Hospital(Gansu Provincial Center Hospital),Lanzhou,Gansu 730000,China)

机构地区：[1]兰州大学第一临床医学院,甘肃兰州730000 [2]兰州大学第一医院重症医学科,甘肃兰州730000 [3]甘肃省妇幼保健院(甘肃省中心医院)重症医学科,甘肃兰州730000

出　　处：《临床肺科杂志》2025年第5期732-738,共7页Journal of Clinical Pulmonary Medicine

基　　金：甘肃省科技计划项目(重点研发计划)(20YF8FA082);甘肃省高等学校创新基金项目(2021B-022)。

摘　　要：目的分析慢性阻塞性肺疾病急性加重期(AECOPD)患者出院后1年内再入院的影响因素,同时探讨红细胞分布宽度与白蛋白比值(RAR)对AECOPD患者出院后1年内再入院的预测价值。方法回顾性纳入2020年10月-2021年10月以第一诊断为AECOPD入住本院的患者295例,根据病情程度将其分为Ⅰ级(n=97)、Ⅱ级(n=119)、Ⅲ级(n=79)。根据患者一年内有无因AECOPD再次入院分为非再入院组210例和再入院组85例。对各组患者的一般资料、实验室指标、肺功能指标进行组间比较。通过受试者工作特征(ROC)曲线评价对一年内有无再入院的预测价值,并计算最佳截断值。依据最佳截断值再次分组,比较两组患者实验室指标、肺功能指标间有无统计学差异。单因素和多因素Logistic回归分析AECOPD一年内再入院的危险因素。结果一年内有无再入院两组患者RAR、吸烟指数、住院时长、NLR、NPAR、PCT、WBC、GLU、FEV_(1)%pred之间有统计学差异(P<0.05)。ROC曲线分析结果显示,RAR的曲线下面积(AUC)为0.852(95%CI:0.806~0.898),最佳截断值为4.3,敏感度为0.768,特异度为0.790。高水平RAR组和低水平RAR组患者一年内再入院率、吸烟指数、住院时长、NLR、NPAR、PCT、FEV_(1)%pred、FEV_(1)/FVC、PEF、RV/TLC之间有统计学差异(P<0.05)。单因素Logistic回归分析结果显示高水平RAR、吸烟指数高、住院时长久、高水平NLR、高水平NPAR、高水平WBC、高水平GLU、低水平FEV_(1)%pred是AECOPD患者一年内再入院的危险因素。进一步的多因素Logistic回归分析显示高水平RAR、吸烟指数高、住院时长久、高水平NLR、高水平GLU、低水平FEV_(1)%pred是AECOPD患者一年内再入院的独立危险因素(P<0.05)。结论RAR是AECOPD患者一年内再入院的独立危险因素,对AECOPD患者一年内再入院具有较高的预测价值。Objective To analyze the influencing factors of readmission within one year after discharge in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD),and to explore the predictive value of the ratio of red cell distribution width to albumin(RAR)for readmission within one year after discharge in AECOPD patients.Methods A total of 295 patients with AECOPD,who were admitted to our hospital from October 2020 to October 2021 with AECOPD as the primary diagnosis,were retrospectively included,and they were divided according to the severity of the disease into Grade I(n=97),Grade II(n=119),and Grade III(n=79).According to whether the patients were readmitted due to AECOPD within one year,they were divided into a non-readmission group(210 cases)and a readmission group(85 cases).General data,laboratory indicators,and lung function indicators were compared between the two groups.The predictive value for readmission within one year was evaluated using the Receiver Operating Characteristic(ROC)curve,and the optimal cutoff value was calculated.Based on this optimal cutoff value,patients were reclassified,and the statistical differences in laboratory indicators and lung function indicators between the two groups were compared.Univariate and multivariate logistic regression analyses were conducted to identify risk factors for readmission within one year in AECOPD patients.Results There were statistically significant differences in RAR,smoking index,length of hospital stay,NLR,NPAR,PCT,WBC,GLU,and FEV_(1)%pred between the two groups with and without readmission within one year(P<0.05).The ROC curve analysis showed that the Area Under the Curve(AUC)for RAR was 0.849,with an optimal cutoff value of 4.3,sensitivity of 0.765,and specificity of 0.790.There were statistically significant differences in the one-year readmission rate,smoking index,length of hospital stay,NLR,NPAR,PCT,FEV_(1)%pred,FEV_(1)/FVC,PEF,and RV/TLC between the high RAR group and the low RAR group(P<0.05).Univariate logistic regression

关 键 词：慢阻肺急性加重期 红细胞分布宽度与白蛋白比值 再入院 预测价值 

分 类 号：R563.9[医药卫生—呼吸系统]