老年营养风险指数对COPD急性加重期患者30 d再入院的预测价值

Predictive value of the Geriatric Nutritional Risk Index for 30-day readmission in patients with Acute Exacerbation of COPD

目的探讨老年营养风险指数(Geriatric Nutritional Risk Index,GNRI)对慢性阻塞性肺疾病急性加重期(Acute Exacerbation of Chronic Obstructive Pulmonary Disease,AECOPD)患者30 d再入院的预测价值。方法回顾性收集324例AECOPD患者的临床资料。根据出院后30 d是否再入院,分为未入院组269例和入院组55例,比较两组临床资料。通过logistic回归分析患者30 d再入院的影响因素。ROC曲线分析单独GNRI以及校准混杂因素后对30 d再入院的评估价值,以决策曲线分析法分析单独GNRI以及校准混杂因素后预测30 d再入院的实用价值。结果入院组长期氧疗占比、CAT评分、白细胞计数、红细胞沉降率显著高于未入院组,第1秒用力呼气容积占预计值的百分比(FEV1%pred)、PaO2、GNRI显著低于未入院组(均P<0.05)。GNRI按四分位数分组,Q4组、Q3组、Q2组、Q1组再入院率分别为4.94%(4/81)、6.17%(5/81)、23.46%(19/81)、33.33%(27/81),差异有统计学意义(P<0.05)。logistic回归分析显示,长期氧疗、FEV1%pred、CAT评分、GNRI为AECOPD患者30 d再入院的影响因素(均P<0.05)。在校正年龄、性别、长期氧疗、CAT评分和FEV1%pred混杂因素前后,GNRI Q3、Q4者再入院风险显著降低(均P<0.05),且OR值呈降低趋势(P<0.05)。GNRI单独预测AECOPD患者30 d再入院的AUC为0.819(95%CI:0.773~0.860),校正混杂因素后AUC为0.858(95%CI:0.815~0.894),校正前后AUC比较,差异无统计学意义(P>0.05)。单独GNRI预测AECOPD患者30 d再入院风险的净获益率为0.04~0.61,校正混杂因素后为0.05~0.70。结论GNRI为AECOPD患者30 d再入院的独立影响因素,可有效预测AECOPD患者30 d再入院的发生。

Objective To explore the predictive value of the Geriatric Nutritional Risk Index(GNRI)for 30-day readmission in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods The clinical data of 324 AECOPD patients were retrospectively collected.According to whether they were readmitted within 30 days of discharge,they were divided into 269 cases in the non-readmission group and 55 cases in the readmission group,and the clinical data of the two groups were compared.The influencing factors of 30-day readmission in AECOPD patients were analyzed by using logistic regression analysis.ROC curves were used to analyze the assessed value of 30-day readmission by GNRI alone as well as after calibrating the confounders.The practical value of predicting 30-day readmission was analyzed by Decision Curve Analysis(DCA)by GNRI alone as well as after calibrating the confounders.Results The percentage of long-term oxygen therapy,CAT score,WBC,and erythrocyte sedimentation rate were significantly higher in the readmission group than those in the non-readmission group,and its FEV1%pred,PaO 2,and GNRI were significantly lower than those in the non-readmission group(all P<0.05).Quartiles of GNRI divided the patients into 4 groups,the readmission rates in GNRI Q4,Q3,Q2,and Q1 group were 4.94%(4/81),6.17%(5/81),23.46%(19/81)and 33.33%(27/81),and the difference was statistically significant(P<0.05).Logistic regression analysis showed that,long-term oxygen therapy,FEV1%pred,CAT score,and GNRI were the influencing factors for 30-day readmission in AECOPD patients(all P<0.05).Before and after calibrating for confounders of age,gender,long-term oxygen therapy,CAT score,and FEV1%pred,the risk of readmission was significantly lower in those with GNRI Q3 and Q4(all P<0.05),and the OR value showed a decreasing trend(P trend<0.05).The AUC of GNRI alone predicting 30-day readmission in AECOPD patients was 0.819(95%CI:0.773-0.860),and the AUC after calibrating for confounders was 0.858(95%CI:0.815-0.894),and the diffe-rence between the AUCs before and after calibrating was not statistically significant(P>0.05).The net benefit of GNRI alone in predicting 30-day readmission was 0.04-0.61,which was 0.05-0.70 after calibrating for confounders.Conclusion GNRI is an independent influencing factor of 30-day readmission in AECOPD patients,and it can effectively predict their occurrence of 30-day readmission.