老年缺血性脑卒中患者非计划性再入院危险因素分析及风险预测模型构建

Risk factors analysis and risk prediction model construction of unplanned readmission in elderly patients with ischemic stroke

目的:了解老年缺血性脑卒中患者发生非计划性再入院的现状和危险因素,并构建风险预测模型。方法:选取2018年9月至2019年10月在北京市某三级甲等医院神经内科住院治疗的328例老年缺血性脑卒中患者为研究对象,采用一般资料调查表、出院准备度量表进行问卷调查,并随访患者至出院后31天。结果:52例(15.9%)患者发生非计划性再入院。回归结果显示,婚姻状况、吸烟史、合并高血压、合并高脂血症、合并房颤、ADL评分、住院天数、出院准备度得分是老年缺血性脑卒中患者非计划性再入院的独立危险因素(P<0.05),ROC曲线下面积(AUC)为0.955,约登指数最大值为0.790,对应的灵敏度为94.2%,特异度为84.8%,截断值为0.148.结论:本研究构建的老年缺血性脑卒中患者非计划性再入院的风险预测模型具有较好的预测效果,可帮助医务人员早期识别老年缺血性脑卒中患者非计划性再入院高危人群。

Objective: To investigate the incidence and risk factors of unplanned readmission in elderly patients with ischemic stroke, and to develop the risk prediction model. Methods: Totally 328 elderly inpatients with ischemic stroke in the neurology ward of a tertiary hospital in Beijing were recruited from September 2018 to October 2019. The general information survey questionnaire and the Readiness for Hospital Discharge Scale(RHDS) were used for the questionnair survey, and the patients were followed up to 31 days after discharge. Results: Totally 52 patients(15.9%) were readmitted. Marital status, smoking, hypertension, hyperlipidemia, atrial fibrillation, ADL score, hospitalization days, and RHDS score were independent risk factors for unplanned readmission in elderly patients with ischemic stroke(P<0.05), AUC was 0.995, the maximum value of the Youden index was 0.790, and the sensitivity was 94.2%, the specificity was 84.8%, and the cutoff value was 0.148. Conclusion: The risk prediction model of unplanned readmission in elderly patients with ischemic stroke established in this study was with a good predictive effect, and it could be used in early identification of those elderly with high-risk in unplanned readmission.