老年COPD稳定期患者病情急性加重再入院的影响因素及预测价值研究

Influencing factors and predictive value of acute exacerbation re-hospitalization in elderly patients with stable chronic obstructive pulmonary disease

目的:探讨老年慢性阻塞性肺疾病(COPD)稳定期患者病情急性加重再入院的相关因素,分析预防管理对策。方法:应用便利抽样法选择2021年6月至2023年10月在本院住院治疗的248例老年COPD稳定期患者进行调查分析,依据出院后3个月是否病情急性加重再入院分为再入院组和对照组。应用二元Logistic回归分析模型探讨老年COPD稳定期患者病情急性加重再入院的影响因素;受试者工作特征(ROC)曲线分析相关因素的预测效力。结果:老年COPD稳定期患者出院后3个月病情急性加重再入院率为24.2%(60/248)。二元Logistic回归分析显示,过去1年因COPD病情急性加重住院次数≥2次、衰弱为患者病情急性加重再入院的危险因素,营养状况良好、FEV_(1)为保护因素。ROC曲线显示,过去1年因COPD病情急性加重住院次数、衰弱、营养状况、FEV_(1)均对预测患者病情急性加重再入院具有一定效能,曲线下面积(AUC)分别为0.623、0.612、0.678、0.658,各指标联合时AUC为0.886,预测效能最高。结论:老年COPD稳定期患者病情急性加重再入院的相关因素包括过去1年因COPD病情急性加重住院次数、衰弱、营养状况、FEV_(1),且上述因素均具有一定预测效力。

Objective:To investigate the factors associated with acute exacerbation re-hospitalization in elderly patients with stable chronic obstructive pulmonary disease(COPD)and to analyze preventive management strategies.Methods:A convenience sampling method was used to select 248 elderly patients with stable COPD who were hospitalized in our hospital from June 2021 to October 2023.The patients were divided into a re-hospitalization group and a control group based on whether they experienced acute exacerbation re-hospitalization within three months after discharge.A binary Logistic regression analysis model was employed to explore the influencing factors for acute exacerbation re-hospitalization in elderly patients with stable COPD.The receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of the related factors.Results:The rate of acute exacerbation re-hospitalization within three months after discharge in elderly patients with stable COPD was 24.2%(60/248).Binary Logistic regression analysis indicated that having two or more hospitalizations due to acute exacerbations of COPD in the past year and frailty were risk factors for acute exacerbation re-hospitalization,while good nutritional status and FEV_(1) were protective factors.The ROC curve showed that the number of hospitalizations due to acute exacerbations of COPD in the past year,frailty,nutritional status,and FEV_(1) all had certain predictive efficacy for acute exacerbation re-hospitalization,with areas under the curve(AUC)of 0.623,0.612,0.678,and 0.658,respectively.When these indicators were combined,the AUC was 0.886,indicating the highest predictive efficacy.Conclusion:The factors associated with acute exacerbation re-hospitalization in elderly patients with stable COPD include the number of hospitalizations due to acute exacerbations of COPD in the past year,frailty,nutritional status,and FEV_(1),all of which have certain predictive efficacy.