慢性阻塞性肺疾病合并肺部感染患者预后影响因素Logistic回归分析及应对措施

Logistic regression analysis of prognostic factors in patients with chronic obstructive pulmonary disease complicated with pulmonary infection and countermeasures

目的 分析慢性阻塞性肺疾病(COPD)合并肺部感染(PI)患者预后影响因素,制定应对措施,促进预后改善。方法 选取2019年1月—2021年7月华北理工大学附属医院241例COPD合并PI患者为研究对象,以28 d为观察终点,统计病死率及其影响因素,建立Logistic回归方程预测模型,评估该模型预测价值。结果 (1)241例COPD合并PI患者28 d病死率为20.75%;(2)Logistic回归方程显示,吸烟(OR:4.153)、糖尿病(OR:6.014)、2型呼吸衰竭(OR:1.782)、侵入性操作(OR:5.856)、联合使用抗生素时间≥14 d(OR:3.503)、血红蛋白<120 g/L(OR:3.503)、住院时间≥15 d(OR:3.939)是COPD合并PI患者死亡的危险因素(P<0.05);(3)Logistic回归模型评价,模型建立具有统计学意义,回归方程的系数差异有统计学意义,模型拟合效果较好。(4)采用Logistic回归模型统计分析数据集,绘制COPD合并PI患者预后的受试者工作特征(ROC)曲线,曲线下面积(AUC)为0.825(95%CI:0.765~0.886)。结论 COPD合并PI患者病死率为20.75%,主要与住院时间、联合使用抗生素、吸烟等因素有关,据此制定应对措施可降低病死率,改善患者生活质量。

Objective To analyze the factors affecting the prognosis of patients with chronic obstructive pulmonary disease(COPD)combined with pulmonary infection(PI),and to formulate countermeasures to improve the prognosis.Methods A total of 241 COPD patients with PI in North China University of Technology,from January 2019 to July 2021 were selected as the research objects.The 28 day observation endpoint was used to calculate the mortality rate and analyze its influencing factors.The Logistic regression equation prediction model was established to evaluate the predictive value of the model.Results①The 28 day mortality rate of 241 COPD patients with PI was 20.75%;②Logistic regression equation showed that smoking(OR:4.153),diabetes(OR:6.014),type 2 respiratory failure(OR:1.782),invasive Sexual operation(OR:5.856),combined use of antibiotics for more than 14 days(OR:3.503),hemoglobin<120 g/L(OR:3.503),and hospitalization for more than 15 days(OR:3.939)were the risk of death in COPD patients with PI factors(P<0.05);③Logistic regression model evaluation,the model establishment has statistical significance.The differences in the coefficients of the regression equations were statistically significant.The model fitting effect is good.④Logistic regression model was used to statistically analyze the data set,and the ROC curve of the prognosis of COPD patients with PI was drawn,and the AUC was 0.825(95%CI:0.765~0.886).Conclusion The fatality rate of patients with COPD and PI is 20.75%,which is mainly related to the length of hospitalization,combined antibiotics,smoking and other factors.Based on this,formulating countermeasures can reduce the fatality rate and improve the quality of life of patients.