| 陈洁,张晓丰,钟明媚.慢性阻塞性肺疾病急性加重住院期间死亡危险因素分析[J].安徽医药,2025,29(2):340-344. |
| 慢性阻塞性肺疾病急性加重住院期间死亡危险因素分析 |
| Exploration of risk factors for mortality in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease |
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| DOI：10.3969/j.issn.1009-6469.2025.02.026 |
| 中文关键词: 肺疾病，慢性阻塞性 死亡 危险因素 年龄 无创通气 |
| 英文关键词: Pulmonary disease,chronic obstructive Mortality Risk factors Age Non-invasive ventilation |
| 基金项目:合肥市卫健委新冠感染疫情防控科研项目( Hwk2020zd002) |
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| 中文摘要: |
| 目的探讨慢性阻塞性肺疾病急性加重( AECOPD)病人住院期间死亡的危险因素。方法将 2019年 1月至 2021年 12月在合肥市第一人民医院住院的 909例 AECOPD病人根据治疗结局分为死亡组( n=48)和生存组( n=861)使用 logistics回归分析筛选住院期间死亡的独立危险因素，并建立回归模型。使用受试者操作特征曲线( ROC曲线)评估该回归，模型对住院死亡的预测能力。利用 R评估病人年龄与院内病死率之间的关系。结果年龄［优势比( OR)=1.20，95%置信区间( CI):(1.09， 1.31)］前一年住院次数［OR=1.49，95%CI:(1.12，1.97)］，动脉血二氧化碳分压［OR=1.07，95%CI:(1.02，1.11)］家庭无创通气［OR=55%CI:(1.37，25.58)］糖尿病［OR=5.49，95%CI:(1.32，22.77)］是 AECOPD病人住院期间死亡的独险因素。五项独立危险因素预测 AECOPD死亡风险的 ROC曲线下面积为 0.93，95%CI:(0.88，0.93)临界值为 0.83，灵敏度和特异度.92，9，立危，住院，分别为 0.88和 0.52。利用分段回归模型进行阈值效应分析，显示最佳拐点年龄为 85岁，大于85，岁病人病死率随年龄增加而增加［OR=2.50，95%CI:(1.40，4.30)］。结论年龄、前一年住院次数、动脉二氧化碳分压、家庭无创通气、糖尿病是 AECOPD病人住院期间死亡的独立危险因素，及早发现 AECOPD病人中有死亡风险的人群，尽早采取针对性措施可能会减少住院短期病死率。 |
| 英文摘要: |
| Objective To investigate the risk factors for in-hospital mortality in patients with acute exacerbation of chronic obstruc-tive pulmonary disease (AECOPD).Methods The included subjects were divided into a death group (n=48) and a survival group (n= 861) according to treatment outcomes in the Hefei First People's Hospital from January 2019 to December 2021. The independent riskfactors of death during hospitalization were screened by logistics regression analysis, and a regression model was established. Receiveroperating characteristic curve (ROC curve) was used to evaluate the predictive power of the regression model for in-hospital deaths. R was used to evaluate the relationship between patient age and in-hospital mortality.Results Age [odds ratio (OR)=1.20, 95% confi-dence interval (CI): (1.09, 1.31)], number of hospitalizations in the previous year [OR=1.49, 95%CI: (1.12, 1.96), arterial partial carbon dioxide pressure [OR=1.07, 95%CI: (1.02, 1.11)], home noninvasive ventilation [OR=5.92, 95% CI: (1.37, 25.58)], diabetes mellitus [OR=5.49, 95%CI:(1.32, 22.77) ,was an independent risk factor for in-hospital death in patients with AECOPD. The area under ROCcurve of five independent risk factors predicting the risk of AECOPD inpatient death was 0.93, 95%CI: (0.88, 0.93), the critical valuewas 0.83, and the sensitivity and specificity were 0.88 and 0.52, respectively. The segmental regression model was used to analyze thethreshold effect, which showed that the optimal turning point was 85 years old, and the mortality of patients after 85 years old increasedwith the increase of age [OR=2.5, 95%CI:(1.40,4.30)].Conclusions Age, the number of hospitalizations in the previous year, home non-invasive ventilation, and diabetes were independent risk factors for the death of AECOPD patients during hospitalization. Early de-tection of those at risk of death in AECOPD patients and early implementation of targeted measures may reduce short-term hospital mor-tality. |
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