Analysis Of Risk Factors For Readmission In Patients With Chronic Obstructive Pulmonary Disease

Purpose:By studying the related indicators that may affect the readmission of patients with COPD,the aim of the paper to find the risk factors affecting the readmission of patients with COPD,and to provide a basis for clinical intervention.Methods:Clinical data of hospitalized patients diagnosed with COPD exacerbation in the Fourth Affiliated Hospital of Nanchang University from June 2021 to February 2022 were collected according to inclusion and exclusion criteria,such as their general information: gender,age,course of disease,educational background,smoking status,BMI,and number of acute exacerbations in the past year.Auxiliary examination indicators: EOS,PH,PaO2,PaCO2,GOLD classification,sputum culture;Scoring scale: non-operative patient nutrition risk assessment scale,venous thrombosis risk assessment scale;Treatment: Whether to use non-invasive ventilator,whether to use systemic glucocorticoid,drug use.Follow-up will be conducted until February 28,2023.According to whether patients with COPD were readmitted within 1 year,they were divided into non-readmitted group and readmitted group.The relevant indicators of the two groups were compared.Multivariate Logistic regression analysis was performed on the risk factors that may affect readmitted patients with acute exacerbation of COPD,and the regression prediction model was constructed,and the distinguishing ability of the model was evaluated by ROC curve.Results:1.A total of 157 patients with AECOPD were included in this study.104 of whom were readmitted without AECOPD,while 53 of whom were readmitt ed with AECOPD within 1 year of follow-up.2.According to the comparison of general conditions between the two groups:the readmission group had the old age,longer course of disease,more times of acute exacerbation hospitalization in the previous year,and lower education level,and the differences were statistically significant(all P < 0.05).There were no significant differences in gender composition,BMI classification between the two groups(all P>0.05).3.There was no significant difference in EOS count,PH,PaO2 and sput um culture between the readmitted group and the non-readmitted group(P >0.05),but the readmitted group had more patients with hypercapnia and higher G OLD grade(P<0.05).4.There was no statistically significant difference between the readmission group and the non-readmission group in whether to use non-invasive ventilator(P >0.05),and the readmission group had more patients who used systemic glucocorticoids,and more patients who used triple and double expansion drugs(P <0.05).5.According to comparison of scores between the two groups: there was no significant difference in the score of venous thromboembolism risk assessment scale between the readmission group and the non-readmission group(P > 0.05),but there was a significant difference in the score of nutritional risk screening NRS-2002 assessment scale(P < 0.05).6.Multivariate logistic regression analysis showed that more times of acut e exacerbation hospitalization in the previous year(OR=2.738,95%CI 1.525-4.913),higher GOLD grade(OR=2.119,95%CI 1.343-3.344);Systemic use of glu cocorticoids during hospitalization(OR=3.261,95%CI 1.205-8.827)was an inde pendent risk factor for readmission in patients with AECOPD.7.The ROC curve of the number of acute exacerbation in the previous year,GOLD stage,and systemic use of glucocorticoids during hospitalization is used to predict that the readmission of COPD patients within 1 year had a sensitivity of66.7%,a specificity of 74.8%,and an area of 0.778.Conclusion:1.The number of acute exacerbation hospitalizations in the previous year,increased GOLD grade,and systemic use of glucocorticoids during hospitalization were independent risk factors for readmission in patients with acute exacerbation of COPD.2.The regression model constructed by the above three independent risk factor variables can predict the readmission risk of AECOPD patients within 1 year,providing a basis for clinical identification of high-risk readmission COPD patients.