To Explore The Effect Of Nutritional Risk On Readmission Within One Year In Patients With Chronic Obstructive Pulmonary Disease (COPD) Based On NRS-2002,Body Mass Index (BMI) And Serum Nutritional Indicators

Objective The purpose of this paper is to assess the nutritional risk of readmitted patients with chronic obstructive pulmonary disease(COPD)within one year through a simple and effective assessment method,to understand the nutritional status of readmitted patients,and to analyze whether the nutritional risk has an impact on readmission,so as to provide a basis for future clinical nutritional intervention,so as to prevent readmission of patients and shorten the time and frequency of readmission.To reduce the economic burden of patients,relieve the pressure of hospital medical resources,and improve the survival time.Methods A total of 2352 COPD patients hospitalized in a local municipal hospital from September 2019 to September 2021 were collected,of which 1435 COPD patients met the inclusion and exclusion criteria.A total of 629 patients with COPD were readmitted to hospital,and 806 patients with COPD were admitted for the first time.150 patients were randomly selected from the readmitted patients as the COPD readmission group,and 150 patients were randomly selected from the first admission patients as the COPD group.The following clinical data were collected,including: 1.General basic information: gender,age,height,weight,comorbidities(hypertension,coronary heart disease,diabetes,cerebrovascular disease and other diseases),C-reactive protein(CRP)2,nutritional risk assessment data: NRS-2002 score table,total lymphocyte count(TLC),prealbumin(PAB),hemoglobin(HB),albumin(ALB)3,lung function: FEV1%preb, FEV1/FVC value.After univariate analysis of the above indicators,Logistic multivariate regression model was used to further analyze the risk factors for readmission within 1 year of COPD.The receiver operating characteristic(ROC)curve was drawn to explore the predictive performance of each nutritional index for COPD patients’ readmission within 1 year.Results A total of 300 samples were included in this study and divided into two groups based on their readmission rate within a year: the COPD readmission group and the COPD group.1.There was no significant difference in age,gender,comorbidities,TLC,HB and CRP between the COPD readmission group and the COPD group(P > 0.05).2.There were significant differences in BMI,NRS-2002 score,ALB and FEV1%preb between the COPD readmission group and the COPD group(P < 0.05).3.Malnutrition was defined as BMI < 18.5kg/m~2,NRS-2002 score >= 3,and PAB<20mg/dl.According to the above criteria,the malnutrition rates in the COPD readmission group were MBI(22%),NRS-2002 score(73%),and PAB(60%),respectively.The malnutrition rates in the COPD readmission group were BMI(10%),NRS-2002 score(42%),and PAB(46%),respectively.4.COPD readmission group and COPD group,BMI,NRS-2002 score,PAB and FEV1%pred value were analyzed by single factor regression analysis.The statistical results showed that BMI,PAB,NRS-2002 score >=3 points and FEV1%pred<50% had statistical significance(P < 0.05).5.Taking the readmission of COPD patients within 1 year after discharge as the dependent variable(readmission =1,no readmission =0),the data with statistical significance(PAB<20mg/dl=1,PAB>=20mg/dl=0;FEV1% < 50%=1,FEV1%>=50% =0;NRS-2002 score>=3=1,NRS-2002 score<3=0;BMI<18.5kg/m~2=1,BMI>=18.5kg/m~2=0)were used as independent variables.Multivariate logistic regression analysis showed that FEV1% < 50% and NRS-2002 score >=3 were independent risk factors for readmission in COPD patients within 1 year.6.Taking the readmission of COPD patients within 1 year after discharge as the end point,the ROC curve of NRS-2002 score for predicting the readmission of COPD patients within 1 year was drawn,and the area under the curve(AUC)was 0.644(95% confidence interval: When NRS-2002 value was 2.5,the Youden index was the largest,the sensitivity was 0.733,and the specificity was 0.540.The ROC curve of FEV1%pred for predicting readmission within 1 year of COPD patients was drawn,and the AUC was 0.686(95% confidence interval: 0.625-0.746).When FEV1%pred value was 42.5%,the Youden index was the largest,the sensitivity was 0.63,and the specificity was 0.72.Combined with NRS-2002 score and FEV1%pred value,the ROC curve was drawn to predict the readmission of COPD patients within 1 year,and the AUC was 0.698(95% confidence interval: 0.639-0.758).Conclusions 1.the decrease of BMI and PAB level,the increase of NRS-2002 score,and the severity of lung function are closely related to the readmission of COPD patients within 1 year.2.NRS-2002 score and FEV1%pred are independent predictors of readmission in COPD patients within 1 year,which have good predictive value for readmission within 1 year.3.To predict the readmission of COPD patients within 1 year,the optimal value of NRS-2002 score was 3 points,and the optimal value of FEV1%pred was 42%.The combination of NRS-2002 and FEV1%pred has a better prediction effect.