老年COPD急性加重期合并呼吸衰竭患者营养不良的危险因素分析及量化预测模型的建立

Analysis of Risk Factors of Malnutrition in Elderly COPD Patients with Acute Exacerbation and Respiratory Failure and Establishment of Quantitative Prediction Model

目的分析老年慢性阻塞性肺疾病(COPD)急性加重期合并呼吸衰竭患者营养不良的危险因素,并建立量化预测模型。方法回顾性分析2018年1月至2020年1月航天中心医院呼吸内科收治的125例老年COPD急性加重期合并呼吸衰竭患者的临床资料,采用单因素和多因素Logistic回归模型分析老年COPD急性加重期合并呼吸衰竭患者营养不良的危险因素;根据危险因素构建风险量化预测模型,并重复1000次抽样纳入数据对模型进行内部验证。结果125例老年COPD急性加重期合并呼吸衰竭患者中发生营养不良者41例,发生率为32.8%。多因素Logistic回归分析结果显示,年龄>75岁(OR=4.850,95%CI 1.436~16.382)、慢性胃病(OR=3.900,95%CI 1.675~9.078)、第一秒用力呼气量(FEV 1)/用力肺活量(FVC)<50%(OR=7.486,95%CI 2.256~24.842)、厌食(OR=3.043,95%CI 1.186~7.813)及低氧血症(OR=2.416,95%CI 0.887~6.576)是老年COPD急性加重期合并呼吸衰竭患者营养不良的危险因素(P<0.05)。基于以上回归分析筛选得到的5个独立危险因素,构建预测老年COPD急性加重期合并呼吸衰竭患者营养不良的列线图模型,并对模型风险预测能力进行验证,预测值C-index指数为0.842(95%CI 0.817~0.867),表明该量化预测模型预测精准度及区分度较好,内部验证的曲线下面积为0.826(95%CI 0.805~0.851),表明该列线图具有较高的预测价值。结论年龄>75岁、慢性胃病、FEV 1/FVC、厌食及低氧血症是老年COPD急性加重期合并呼吸衰竭患者营养不良的危险因素,且本研究建立的量化模型可以较准确地预测营养不良的发生风险。

Objective To analyze the risk factors of malnutrition in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)with respiratory failure,and establish a quantitative prediction model.Methods The clinical data of 125 elderly patients with acute exacerbation of COPD and respiratory failure admitted to Department of Respiratory Medicine of Aerospace Central Hospital from Jan.2018 to Jan.2020 were retrospectively analyzed,and univariate and multivariate Logistic regression models were used to analyze the risk factors of malnutrition in the patients.The risk quantitative prediction model was constructed according to the risk factors,and 1000 times repeated sampling were done to include the data to verify the model internally.Results Among the 125 elderly patients,41 were at risk of malnutrition,with an incidence of 32.8%.Multivariate Logistic regression analysis showed that age>75 years old(OR=4.850,95%CI 1.436-16.382),chronic gastric disease(OR=3.900,95%CI 1.675-9.078),forced expiratory volume in first second(FEV 1)/forced vital capacity(FVC)<50%(OR=7.486,95%CI 2.256-24.842),anorexia(OR=3.043,95%CI 1.186-7.813)and hypoxemia(OR=2.416,95%CI 0.887-6.576)were risk factors of nutritional risk in the patients(P<0.05).Based on the 5 independent risk factors screened by the above regression analysis,a nomogram model was constructed to predict the nutritional risk of elderly patients with acute exacerbation of COPD combined with respiratory failure,and the risk prediction ability of the model was verified.The predicted value C-index was 0.842(95%CI 0.817-0.867),indicating that the quantitative prediction model had a good prediction accuracy and discrimination.The internally verified area under curve was 0.826(95%CI 0.805-0.851),indicating that the nomogram had a high predictive value.Conclusion Age>75 years old,chronic gastric disease,FEV 1/FVC<50%,anorexia and hypoxemia are risk factors for malnutrition in the elderly COPD patients with acute exacerbation and respiratory failure,and the quantitative model established in this study can accurately predict the occurrence risk of malnutrition.