慢性阻塞性肺疾病患者出院后30天内再入院风险预测模型的系统评价

Risk prediction models for readmission within 30 days after discharge in patients with chronic obstructive pulmonary disease:a systematic review

目的 系统评价慢性阻塞性肺疾病患者出院后30天内再入院风险预测模型,为临床选择风险评估工具提供借鉴。方法 计算机检索CNKI、WanFang Data、VIP、CBM、PubMed、Embase、Web of Science、Cochrane Library数据库中与研究目的相关的文献,检索时限均为建库至2023年4月25日。文献筛选和数据提取由2名研究者独立进行,采用预测模型研究的偏倚风险评估工具对纳入文献的偏倚风险和适用性进行评价。结果 共纳入8项研究,包含14个慢性阻塞性肺疾病患者出院后30天内再入院风险预测模型,总样本量为125~8 263例,结局事件数为24~741例,受试者工作特征曲线下面积为0.58~0.918。纳入模型最常见的前5个预测因子为吸烟、合并症、年龄、文化程度、家庭氧疗。8项研究均存在一定的偏倚风险,主要是因为模型样本量较小、未报告盲法、缺乏外部验证、缺失数据处理不恰当。结论 慢性阻塞性肺疾病患者出院后30天内再入院风险预测模型整体预测性能较好,但整体研究质量较低,未来应持续改进模型,为临床早期识别慢性阻塞性肺疾病患者出院后30天内再入院高危人群提供科学的评估工具。

Objective To systematically review the risk prediction models for readmission within 30 days after discharge in patients with chronic obstructive pulmonary disease(COPD),and provide a reference for clinical selection of risk assessment tools.Methods Databases including CNKI,Wanfang Data,VIP,CBM,PubMed,Embase,Web of Science,and Cochrane Library were searched for literature on this topic.The search time was from the inception of the database to April 25,2023.Literature screening and data extraction were performed by two researchers independently.The risk of bias and applicability of the included literature were evaluated using the risk of bias assessment tool for predictive model studies.Results A total of 8 studies were included,including 14 risk prediction models for 30-day readmission of COPD patients after discharge.The total sample size was 125~8263,the number of outcome events was 24~741,and the area under the receiver operating characteristic curve was 0.58~0.918.The top five most common predictors included in the model were smoking,comorbidities,age,education level,and home oxygen therapy.Although five studies had good applicability,all eight studies had a certain risk of bias.This is mainly due to the small sample size of the model,lack of reporting of blinding,lack of external validation,and inappropriate handling of missing data.Conclusion The overall prediction performance of the risk prediction model for 30-day readmission of patients with COPD after discharge is good,but the overall research quality is low.In the future,the model should be continuously improved to provide a scientific assessment tool for the early clinical identification of patients with COPD at high risk of readmission within 30 days after discharge.