慢性阻塞性肺疾病测试与急性加重出院后3个月内再入院风险相关性分析

Analysis of the relationship between chronic obstructive pulmonary disease test score and the risk of re.admission after acute exacerbation of chronic obstructive pulmonary disease discharge

目的:探讨慢性阻塞性肺疾病测试评分(CAT)与慢性阻塞性肺疾病急性加重(AECOPD)治疗后3个月内再入院的相关性。方法:选取2018年10月至2019年8月,因AECOPD入院,且能够独立完成CAT测试的患者。分别在入院时、出院时进行CAT测试。出院后随访3个月,所有入组患者分为再入院组与未再入院组。分别比较入院时两组间基线特征。采用Logistic回归分析,出、入院时CAT、出院时氧分压、二氧分碳分压、血红蛋白与再入院风险。ROC评估出院时CAT、治疗前后CAT差值预测再入院能力。结果:入院时,再入院组CAT评分显著高于未再入院组,差异有统计学意义(P=0.001)。经治疗后所有患者CAT评分均有下降,其中未再入院组要明显低于再入院组,两组间治疗前后CAT差值变化比较,差异有统计学意义(P<0.001)。通过线性回归分析两组间出院时CAT评分,差异有统计学意义。出院时CAT、PCO2、HGB与再入院时风险回归分析,模型具有统计学意义(χ2=87.02,P<0.001),随着出院时CAT及pCO2的增高,其再入院风险呈增高趋势。出院时HGB白量虽然与再入院有关,但风险较小。ROC曲线分析发现出院时CAT预测再入院的曲线下面积为0.775,其敏感性、特异性分别为0.62、0.83。CAT差值的曲线下面积为0.897,其敏感性、特异性分别为0.89、0.76。结论:AECOPD出院时CAT和治疗前后CAT差值对预测3个月内再入院的风险有较好的敏感性和特异性,对临床可能有一定的指导意义。

Objective:To investigate the correlation between the chronic obstructive pulmonary disease test score(CAT)and readmission within 3 months after treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:Patients who were admitted to AECOPD from October 2018 to August 2019 and were able to complete the CAT test independently.CAT tests were performed at admission and discharge.All patients were followed up for 3 months after discharge.All patients were divided into readmission group and non-readmission group.Baseline characteristics were compared between the two groups at admission.Logistic regression model was used to analyze CAT,pO2,pCO2,HGB and the risk of readmission.ROC assessed CAT at discharge and the CAT difference before and after treatment to predict readmission.Results:At the time of admission,the CAT score in the readmission group was significantly higher than that in the non-readmission group,and the difference was statistically significant(P=0.001).After treatment,the CAT score of all patients decreased.The non-readmission group was significantly lower than the readmission group.The difference in CAT difference between the two groups before and after treatment was statistically significant(P<0.001).The difference in CAT scores between discharges was statistically significant by linear regression analysis.Logistic model was statistically significant(X2=87.02,P<0.001).As CAT and pC02 increased at discharge,the risk of readmission increased.The amount of hemoglobin at discharge,although related to readmission,is less risky.ROC curve analysis found that the area under the curve of CAT predicting readmission at discharge was 0.775,and its sensitivity and specificity were 0.62 and 0.83,respectively.The area under the curve of CAT difference is 0.897,and its sensitivity and specificity are 0.89 and 0.76,respectively.Conclusions:CAT at discharge and the difference of CAT have good sensitivity and specificity in predicting readmission with 3 months after discharge of AECOPD.and these findings may have certain guiding significance for the clinical practice.