慢性阻塞性肺疾病急性加重病人再入院风险预测模型构建及护理策略研究

    Construction of a risk prediction model and research on nursing strategies for readmission of patients with acute exacerbation of chronic obstructive pulmonary disease

    • 摘要:
      目的: 基于健康社会决定因素(SDH)理论对慢性阻塞性肺疾病(COPD)出院病人进行追踪,构建COPD急性加重(AECOPD)病人再入院预测风险模型,为降低再入院实施精准防控提供依据。
      方法: 选取AECOPD病人166例,随访12个月,记录再入院发生情况。收集SDH、行为心理、临床指标,单因素及多因素logistic回归筛选危险因素,构建列线图模型;采用ROC曲线、校准曲线验证模型效能;采用决策曲线(DCA)评估临床收益。
      结果: 共50例(30.12%)发生 AECOPD再入院。多因素logistic回归显示,无居家氧疗、家庭关怀低下、健康素养不足、恐惧疾病进展、既往1年急性加重史、mMRC分级升高、合并症≥4种为再入院独立危险因素(P < 0.05)。模型的AUC为0.935(95%CI:0.893 ~ 0.978),区分度极高,灵敏度为86.0%,特异度为89.7%;校准曲线拟合良好。DCA评估模型具有良好的临床实用性。
      结论: 基于SDH构建的AECOPD再入院风险模型预测效能良好。

       

      Abstract:
      Objective To track discharged patients with chronic obstructive pulmonary disease (COPD) based on the Health Social Determinants (SDH) theory, construct a predictive risk model for readmission in patients with acute exacerbation of COPD (AECOPD), and provide a basis for implementing precise prevention and control to reduce readmission.
      Methods A total of 166 patients with AECOPD were selected, and followed up for 12 months. The occurrence of readmission was recorded. The SDH, behavioral psychology and clinical indicators were collected. Univariate and multivariate logistic regression were used to screen rhe risk factors, and a nomogram model was constructed. The model efficacy was verified by using the ROC curve and calibration curve. Clinical benefits were evaluated using the decision curve (DCA).
      Results A total of 50 cases (30.12%) were readmitted due to AECOPD. The rersults of Multivariate logistic regression showed that no home-based oxygen therapy, low family care, insufficient health literacy, fear of disease progression, history of acute exacerbation within one year in the past, mMRC grade elevating and ≥4 comorbidities were the independent risk factors of readmission (P < 0.05). The AUC of the model was 0.935 (95%CI: 0.893−0.978), with extremely high discrimination, a sensitivity of 86.0% and a specificity of 89.7%. The calibration curve fited well. The DCA evaluation model had good clinical practicability.
      Conclusions The AECOPD readmission risk model constructed based on SDH has good predictive efficacy.

       

    /

    返回文章
    返回