[1]贺 芳,孟凡亮.构建AECOPD患者风险模型的临床价值[J].医学信息,2024,37(06):115-119.[doi:10.3969/j.issn.1006-1959.2024.06.019]
　HE Fang,MENG Fan-liang.Clinical Value of Constructing a Risk Model for Patients with AECOPD[J].Journal of Medical Information,2024,37(06):115-119.[doi:10.3969/j.issn.1006-1959.2024.06.019]
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构建AECOPD患者风险模型的临床价值()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
37卷
期数:
2024年06期
页码:
115-119
栏目:
论著
出版日期:
2024-03-15

文章信息/Info

Title:
Clinical Value of Constructing a Risk Model for Patients with AECOPD
文章编号:
1006-1959（2024）06-0115-05
作者:
贺 芳; 孟凡亮
（安徽医科大学附属巢湖医院呼吸内科，安徽 合肥 238000）
Author(s):
HE Fang; MENG Fan-liang
(Department of Respiratory Medicine,Chaohu Hospital of Anhui Medical University,Hefei 238000,Anhui,China)
关键词:
慢性阻塞性肺疾病; 急性加重; 风险模型
Keywords:
Chronic obstructive pulmonary disease; Acute exacerbation; Risk model
分类号:
R563.9
DOI:
10.3969/j.issn.1006-1959.2024.06.019
文献标志码:
A
摘要:
目的 对慢性阻塞性肺疾病（COPD）患者1年内发生急性加重的影响因素进行研究，建立和验证风险模型。方法 收集2020年1月-2021年12月安徽医科大学附属巢湖医院呼吸内科612例AECOPD患者的一般资料，其中2020年1月-12月的324例AECOPD患者为建模组，2021年1月-12月的288例AECOPD患者为验证组，通过Logistic回归单因素分析选取用于建立AECOPD患者风险模型的因素，根据Logistic回归多因素分析危险预测因素，并据此建立最终的风险模型。通过受试者工作特征曲线（ROC）、校准曲线及临床决策曲线（DCA）评估此模型的预测价值。结果 FEV1%预计值、既往加重次数、嗜酸性粒细胞百分比（EOS%）、血清白蛋白、三联用药史（ICS+LABA+LAMA）是患者1年内发生急性加重的影响因素，由此建立风险模型公式为：P＝1/(1+e-x)，x＝2.796－0.018×FEV1%预计值＋1.516×既往加重次数－0.098×血清白蛋白＋0.206×EOS%－1.169×三联用药史，e为自然对数。ROC曲线下面积为0.839，以最大约登指数（0.579）选取最佳临界值为0.221，灵敏度为80.00%，特异度为77.90%。结论 FEV1%预计值、既往加重次数、EOS%、血清白蛋白、三联用药史（ICS+LABA+LAMA）是患者1年内发生急性加重的影响因素，由此建立COPD患者急性加重的风险模型。此模型具有良好的区分度和校准度，且临床决策效益方面表现良好，可协助医护人员对加重风险较高的患者进行早期干预，防止病情进一步进展。
Abstract:
Objective To study the influencing factors of acute exacerbation in patients with chronic obstructive pulmonary disease (COPD) within 1 year, and to establish and verify the risk model.Methods The general data of 612 AECOPD patients in the Department of Respiratory Medicine of Chaohu Hospital of Anhui Medical University from January 2020 to December 2021 were collected. Among them, 324 AECOPD patients from January to December 2020 were used as the modeling group, and 288 AECOPD patients from January to December 2021 were used as the validation group. The factors used to establish the risk model of AECOPD patients were selected by Logistic regression univariate analysis, and the risk predictors were analyzed by Logistic regression multivariate analysis, and the final risk model was established accordingly. The predictive value of this model was evaluated by receiver operating characteristic curve (ROC), calibration curve and clinical decision curve (DCA).Results FEV1% predicted value, previous exacerbations, EOS%, serum albumin, and the history of triple drug use (ICS+LABA+LAMA) were the factors influencing the occurrence of acute exacerbationsin the patients within one year. From this, the risk prediction model formula was established: P=1/(1+e-x), x=2.796-0.018×FEV1% predicted value+1.516×previous exacerbations-0.098×serum albumin+0.206×EOS%-1.169×history of triple medication, e was the natural logarithm. The area under the ROC curve was 0.839, and the optimal cut-off value was 0.221 based on the approximate index (0.579), with a sensitivity of 80.00% and a specificity of 77.90%.Conclusion FEV1% predicted value, previous exacerbations, EOS%, serum albumin, and the history of triple use (ICS+LABA+LAMA) are the factors influencing the occurrence of acute exacerbations in the patients within one year. Based on this, the risk prediction model of acute exacerbation in COPD patients is successfully constructed. The model has good discrimination, calibration, and clinical decision-making benefits, and can assist healthcare professionals in the early intervention of patients at high risk of exacerbation to prevent further progression.

参考文献/References:

[1]Christenson SA,Smith BM,Bafadhel M,et al.Chronic obstructive pulmonary disease[J].Lancet,2022,399(10342):2227-2242.[2]Lindberg A,Lindberg L,Sawalha S,et al.Large underreporting of COPD as cause of death-results from a population-based cohort study[J].Respiratory Medicine,2021,186:106518.[3]鲍洪杰.肝素结合蛋白在慢阻肺急性加重中的预测价值[D].郑州:郑州大学,2019.[4]Bellou V,Belbasis L,Konstantinidis AK,et al.Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease:systematic review and critical appraisal[J]. BMJ,2019,367:l5358.[5]Guirguis-Blake JM,Senger CA,Webber EM,et al.Screening for chronic obstructive pulmonary disease:evidence report and systematic review for the US Preventive Services Task Force[J].JAMA,2016,315(13):1378-1393.[6]Crisafulli E,Barbeta E,Ielpo A,et al.Management of severe acute exacerbations of COPD:an updated narrative review[J]. Multidiscip Respir Med,2018,13:36.[7]Mekanimitdee P,Morasert T,Patumanond J,et al.The MAGENTA model for individual prediction of in-hospital mortality in chronic obstructive pulmonary disease with acute exacerbation in resource-limited countries:A development study[J].PLoS One,2021,16(8):e0256866.[8]Suissa S,Dell’Aniello S,Ernst P.Long-term natural history of chronic obstructive pulmonary disease:severe exacerbations and mortality[J].Thorax,2012,67(11):957-963.[9]Wu YK,Lan CC,Tzeng IS,et al.The COPD-readmission (CORE) score:a novel prediction model for one-year chronic obstructive pulmonary disease readmissions[J].Journal of the Formosan Medical Association,2021,120(3):1005-1013.[10]Tsoumakidou M,Tzanakis N,Voulgaraki O,et al.Is there any correlation between the ATS,BTS,ERS and GOLD COPD’s severity scales and the frequency of hospital admissions?[J].Respiratory Medicine,2004,98(2):178-183.[11]Kong CW,Wilkinson TMA.Predicting and preventing hospital readmission for exacerbations of COPD[J].ERJ Open Res,2020,6(2):00325-2019.[12]Celli BR.Pharmacological therapy of COPD:reasons for optimism[J].Chest,2018,154(6):1404-1415.[13]Chen L,Chen S.Prediction of readmission in patients with acute exacerbation of chronic obstructive pulmonary disease within one year after treatment and discharge [J].BMC Pulmonary Medicine,2021,21(1):1-17.[14]Tavakoli H,Johnson KM,FitzGerald JM,et al.Trends in prescriptions and costs of inhaled medications in chronic obstructive pulmonary disease:a 19-year population-based study from Canada[J].International Journal of Chronic Obstructive Pulmonary Disease,2019:2003-2013.[15]Vedel-Krogh S,Nielsen SF,Lange P,et al.Blood eosinophils and exacerbations in chronic obstructive pulmonary disease.The Copenhagen General Population Study[J].American Journal of Respiratory and Critical Care Medicine,2016,193(9):965-974.[16]Couillard S,Larivée P,Courteau J,et al.Eosinophils in COPD exacerbations are associated with increased readmissions[J].Chest,2017,151(2):366-373.[17]Kolsum U,Damera G,Pham TH,et al.Pulmonary inflammation in patients with chronic obstructive pulmonary disease with higher blood eosinophil counts[J].Journal of Allergy and Clinical Immunology,2017,140(4):1181-1184.[18]赵京梅,王永红,李国翔,等.对住院慢阻肺患者营养风险临床调查分析[J].临床肺科杂志,2018,23(6):1098-1100.[19]刘魁,钱会,韩可兴,等.135例COPD急性加重患者营养状况及其与急性加重的关系分析[J].中华全科医学,2020,18(8):1313-1315,1347.

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更新日期/Last Update: 1900-01-01