Development of a Nomogram to Predict the Risk of 30-Day Re-Exacerbation for Patients Hospitalized for Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Development of a Nomogram to Predict the Risk of 30-Day Re-Exacerbation for Patients Hospitalized for Acute Exacerbation of Chronic Obstructive Pulmonary Disease
复制标题
开发列线图来预测因慢性阻塞性肺疾病急性加重住院的患者 30 天再次恶化的风险
DOI：
10.1080/15412555.2019.1606187
复制
发表时间：
2019-03-04
影响因子：
2.2
通讯作者：
Zhang, Jing
中科院分区：
文献类型：
--
作者：
Hu, Wei-ping;Lhamo, Tsokyi;Zhang, Jing
急性加重(AE)是慢性阻塞性肺疾病(COPD)患者致残率和死亡率增加的主要原因。AECOPD住院患者出院后短期再加重是很常见的。因此，我们的目标是设计一个评分系统，使用简单和容易获得的变量来有效地预测30天后的再加重。我们回顾了2005至2017年间在两家中国医院住院的686例AECOPD患者。收集缓解期和发作期患者的人口学特征、临床表现和治疗情况。用最小Akaike信息准则(AIC)确定多变量Logistic分析中的最优协变量子集，并进一步利用AIC建立一个实用可靠的诺模图来预测30天内的再加重。通过协调性指数(C-index)和校准图对诺模图的有效性进行了内部验证。30d再加重发生率为15.8%。基于最小的AIC，图中包含了8个容易获得的参数，包括性别、COPD评估试验(CAT)评分、前一年有呼吸衰竭的AE、新的化痰、新的心血管事件、联合抗生素治疗、AE的茶碱治疗和ICU入院。我们的诺模图显示了很好的区分能力，C指数为0.702。校正曲线表明，诺模图预测的概率与实际观测结果吻合较好。结合8个常用变量，构建了AECOPD患者出院后30天再加重的诺模图，该图具有较高的预测性能，有助于预测AECOPD患者出院后再加重的个性化风险，为患者提供个性化的出院后支持。
Acute exacerbation (AE) is the main cause of increased disability and mortality for patients with Chronic Obstructive Pulmonary Disease (COPD). Short-term re-exacerbation after discharge is common for in-hospital patients with AECOPD. Thus, we aimed to design a scoring system to effectively predict the 30-day re-exacerbation using simple and easily accessible variables. We retrospectively enrolled 686 cases hospitalized for AECOPD in two Chinese hospitals from 2005 to 2017. A variety of parameters were collected like demographics, clinical manifestations and treatments in stable and AE period. The optimal subset of covariates in the multivariate logistic analysis was identified by the smallest Akaike Information Criterion (AIC) and was further used to develop a practical and reliable nomogram to predict the 30-day re-exacerbation. The efficacy of the nomogram was internally validated by concordance index (C-index) and a calibration plot. The incidence of 30-day re-exacerbation was 15.8%. Based on the smallest AIC, eight easily-accessible parameters were included in the nomogram, including sex, COPD assessment test (CAT) scores, AE with respiratory failure in the previous year, new purulent sputum, new cardiovascular events, combined antibiotic therapy, theophylline therapy for AE and ICU admission. Our nomogram revealed good discriminative ability with the C-index of 0.702. The calibration curve showed good agreement between nomogram-predicted probability and actual observation. Incorporating eight common variables, a nomogram for 30-day re-exacerbation after discharge with high predictive performance was constructed for patients with AECOPD, which was helpful in predicting individualized risk of re-exacerbation and offering individualized post-discharge support.