The influencing factors of readmission within 90 days for weak patients with chronic obstructive pulmonary disease and construction of an early warning model

doi:10.11958/20251088

Abstract

Abstract:

Objective To explore the influencing factors of readmission within 90 days in frail patients with chronic obstructive pulmonary disease (COPD), construct an early warning model and evaluate its discrimination and effectiveness. Methods A total of 831 COPD patients with frailty were included and divided into the readmission group (290 cases) and the control group (541 cases) based on whether they were readmitted within 90 days after discharge. The electronic medical record data were collected and compared between the two groups of patients. Multivariate Logistic regression analysis was used to screen independent influencing factors for readmission within 90 days in COPD weak patients. A predictive model was established. The column chart was drawn. The discriminability of the predictive model was evaluated through receiver operating characteristic (ROC) curves. The clinical practicality and the predictive model calibration were evaluated through decision curves and calibration curves. Results The body mass index (BMI) of the readmission group was lower than that of the non readmission group, and the proportion of acute exacerbation of COPD hospitalizations ≥ 2 times in the past year， the Edmonton frailty scale (REFS) score and the Chalson comorbidity index (CCI) were higher in the readmission group than those of the non readmission group (P<0.05). Multivariate Logistic regression analysis showed that BMI (OR=0.721, 95%CI: 0.636-0.818), the number of acute exacerbations of COPD hospitalizations in the past year (OR=3.040, 95%CI: 1.944-4.753), REFS score (OR=1.726, 95%CI: 1.486-2.005) and CCI score (OR=3.917, 95%CI: 3.079-4.983) were all independent influencing factors for readmission within 90 days in COPD frail patients (P<0.05). Based on the results of multiple factor Logistic regression analysis, the column chart warning model was constructed. The AUC value of the ROC curve was 0.847 (95%CI: 0.820-0.874), the specificity was 87.20% and the sensitivity was 64.50%. The calibration curve of the predictive model was close to the diagonal, and the calibrationa degree was good. The decision curve suggested that the prediction model had clinical practicality. Conclusion The early warning model constructed based on the influencing factors of readmission hospitalization within 90 days in weak patients with COPD has good predictive effect and clinical practicability.

Key words: pulmonary disease, chronic obstructive, asthenia, patient readmission, root cause analysis

CLC Number:

R563.9

Figures/Tables 6

References 19

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组别		n	性别（男/女）				年龄/岁			BMI/（kg/m²）			吸烟史			高血压			糖尿病			冠心病
对照组		541	411/130				78.36±6.01			23.20±1.51			77（14.2）			278（51.4）			84（15.5）			189（34.9）
再入院组		290	230/60				77.91±5.83			22.31±1.45			32（11.0）			141（48.6）			55（19.0）			105（36.2）
t或χ²			1.194				1.036			8.195^＊＊			1.695			0.578			1.603			0.134
组别	心力衰竭			脑卒中		低蛋白血症			hs-CRP/（mg/L）			WBC/（×10⁹/L）			LYM/（×10⁹/L）			NEUT/（×10⁹/L）			PLT/（×10⁹/L）
对照组	173（32.0）			127（23.5）		48（8.9）			3.70±1.19			7.80±1.47			1.36±0.50			5.75±1.62			186.09±29.79
再入院组	95（32.8）			70（24.1）		30（10.3）			3.58±1.18			7.90±1.53			1.34±0.34			5.82±1.61			184.85±26.13
t或χ²	0.053			0.046		0.481			1.337			0.916			0.602			0.602			0.595
组别	Scr/ （μmol/L）				BUN/ （mmol/L）			ALB/ （g/L）			过去1年COPD急性加重住院次数≥2次			REFS 评分/分			CCI 评分/分			mMRC 评分/分			CAT 评分/分
对照组	74.90±14.58				7.15±1.60			38.16±8.18			73（13.49）			10.34±1.27			2（1，3）			3.22±0.67			15.20±1.30
再入院组	75.11±9.58				7.00±1.46			37.50±6.21			95（32.76）			11.22±1.24			3（2，4）			3.25±0.52			15.10±1.59
Z、t或χ²	0.225				1.299			1.214			43.443^＊＊			9.605^＊＊			13.218^＊＊			0.690			1.010

组别		n	性别（男/女）				年龄/岁			BMI/（kg/m²）			吸烟史			高血压			糖尿病			冠心病
对照组		541	411/130				78.36±6.01			23.20±1.51			77（14.2）			278（51.4）			84（15.5）			189（34.9）
再入院组		290	230/60				77.91±5.83			22.31±1.45			32（11.0）			141（48.6）			55（19.0）			105（36.2）
t或χ²			1.194				1.036			8.195^＊＊			1.695			0.578			1.603			0.134
组别	心力衰竭			脑卒中		低蛋白血症			hs-CRP/（mg/L）			WBC/（×10⁹/L）			LYM/（×10⁹/L）			NEUT/（×10⁹/L）			PLT/（×10⁹/L）
对照组	173（32.0）			127（23.5）		48（8.9）			3.70±1.19			7.80±1.47			1.36±0.50			5.75±1.62			186.09±29.79
再入院组	95（32.8）			70（24.1）		30（10.3）			3.58±1.18			7.90±1.53			1.34±0.34			5.82±1.61			184.85±26.13
t或χ²	0.053			0.046		0.481			1.337			0.916			0.602			0.602			0.595
组别	Scr/ （μmol/L）				BUN/ （mmol/L）			ALB/ （g/L）			过去1年COPD急性加重住院次数≥2次			REFS 评分/分			CCI 评分/分			mMRC 评分/分			CAT 评分/分
对照组	74.90±14.58				7.15±1.60			38.16±8.18			73（13.49）			10.34±1.27			2（1，3）			3.22±0.67			15.20±1.30
再入院组	75.11±9.58				7.00±1.46			37.50±6.21			95（32.76）			11.22±1.24			3（2，4）			3.25±0.52			15.10±1.59
Z、t或χ²	0.225				1.299			1.214			43.443^＊＊			9.605^＊＊			13.218^＊＊			0.690			1.010

变量	β	SE	Wald χ²	P	OR	OR 95%CI
BMI	-0.327	0.064	26.029	<0.001	0.721	0.636~0.818
过去1年COPD急性加重住院次数	1.112	0.228	23.777	<0.001	3.040	1.944~4.753
REFS评分	0.546	0.076	50.952	<0.001	1.726	1.486~2.005
CCI评分	1.365	0.123	123.497	<0.001	3.917	3.079~4.983
常数项	-2.703	1.695	2.543	0.111	0.067

变量	β	SE	Wald χ²	P	OR	OR 95%CI
BMI	-0.327	0.064	26.029	<0.001	0.721	0.636~0.818
过去1年COPD急性加重住院次数	1.112	0.228	23.777	<0.001	3.040	1.944~4.753
REFS评分	0.546	0.076	50.952	<0.001	1.726	1.486~2.005
CCI评分	1.365	0.123	123.497	<0.001	3.917	3.079~4.983
常数项	-2.703	1.695	2.543	0.111	0.067