Study On Risk Factors Of Readmission In Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Background and purpose:Chronic Obstructive Pulmonary Disease(COPD)is a preventable and treatable respiratory disease characterized by persistent respiratory symptoms and airflow limitation.Chronic obstructive pulmonary disease(COPD)can only be diagnosed by the presence of persistent airflow limitation and the exclusion of other known causes of airflow limitation.Combined with the symptoms of COPD patients,the risk assessment of acute exacerbation and lung function changes,patients can be divided into A,B and E groups to select the main treatment drugs in the stable phase.When the patient has more severe respiratory symptoms than usual,such as increased sputum volume and yellow purulent sputum,it is necessary to change the medication regimen,and even need to be hospitalized for treatment.It is called Acute exacerbation of chronic obstructive pulmonary disease(AECOPD).The identification of risk factors for readmission for AECOPD within one year provides a basis for guiding the diagnosis and treatment of patients in underdeveloped medical areas where pulmonary function testing is difficult to be popularized,or whose physical conditions are difficult to cooperate with bronchodilation test.Data and Methods:1.A total of 223 patients with AECOPD who were hospitalized Hospital from December 1,2020 to December 1,2021 were enrolled,and the clinical data of the patients were collected.2.The clinical data of 223 patients were divided into readmission group(90 cases)and control group(133 cases).Readmission group: patients were re-hospitalized due to acute exacerbation of COPD within 1 year after the first hospitalization.The patients in the control group were not rehospitalized due to acute exacerbation of COPD within 1 year after this hospitalization.3.Clinical data of all subjects were collected,including general information:gender,age,place of residence,body mass index(BMI),smoking history,drinking history,complications(hypertension,diabetes,coronary heart disease,pulmonary encephalopathy,pulmonary heart disease,hypoproteinemia,lower extremity thrombosis),auxiliary examination: Procalcitonin(PCT),D-dimer,peripheral white blood cell count,neutrophil count,lymphocyte count,eosinophil count,pulmonary function,ADL score,blood gas analysis,hospitalization: duration of systemic hormones,duration of intravenous antibiotics,length of hospital stay,and out-of-home treatment at discharge: Whether inhaled drugs were used,the regularity of drug use,the correctness of drug use,oxygen therapy(whether oxygen therapy and daily oxygen therapy for 15 hours),pulmonary rehabilitation(whether pulmonary rehabilitation and daily pulmonary rehabilitation for more than 2 hours),etc.4.SPSS 26.0 software was used to analyze the data,and the count data were expressed by the number of cases(constituent ratio).Chi-square test was used for comparison of count data between groups.The measurement data conforming to normal distribution were expressed as mean ± standard deviation((?)±s),and the differences between the two groups were compared by two-sample t test.The measurement data that did not meet the normal distribution were expressed as median(range),and the differences between the two groups were compared by non-parametric rank sum test.Logistic regression analysis was used to evaluate the risk ratio(OR)of readmission within 1 year in AECOPD patients,and ROC curve was used to calculate the relevant probability.Results:1.Comparison between readmission group and control group: The difference of education level between the two groups was statistically significant(P=0.013),and the difference of body mass index(BMI)between the two groups was statistically significant(P=0.019).Coronary heart disease(P=0.001),lower extremity venous thrombosis(P=0.019),anxiety and depression(P=0.016),pulmonary hypertension(P=0.040),pulmonary heart disease(P < 0.001),and respiratory failure(P < 0.001)were more likely to have acute readmission.Compared with the control group,the lymphocyte count(P=0.016)decreased and the neutrophil/lymphocyte ratio(P=0.012)increased in the readmission group.There were significant differences in the percentage of predicted FEV1(P < 0.001),ADL score(P=0.005)and oxygen therapy(P < 0.001)between the two groups.The accuracy(P < 0.001)and regularity(P <0.001)of using inhaled drugs in the control group were better than those in the readmission group,and the duration of oxygen therapy(P < 0.001),use of antibiotics(P < 0.009),use of systemic hormones(P < 0.018)and length of hospital stay(P <0.004)were shorter than those in the readmission group.2.The factors with significant differences between the readmission group and the control group(P≤0.001)were included in the univariate Logistic regression analysis,and the results showed that coronary heart disease(OR=2.146,95%CI: 1.147-4.014,P=0.017);Worse lung function(OR=1.617,95%CI: 1.005-2.604,P=0.048)and longer duration of oxygen therapy(OR=2.329,95%CI: 1.181-4.595,P=0.015)increased the probability of readmission for COPD patients with acute exacerbation.3.The receiver operating characteristic curve(ROC)of the model showed that the AUC of coronary heart disease was 0.612,and the maximum Youden index was0.224.The sensitivity and specificity were 62.2% and 60.2%,respectively.The AUC of lung function(%pred)was 0.654,and the maximum Youden index was 0.253,with a sensitivity of 41.1% and a specificity of 84.2% for the diagnosis of readmission probability of COPD exacerbation.The AUC of oxygen therapy was 0.614,and the maximum Youden index was 0.223.At this time,the sensitivity and specificity of oxygen therapy for the diagnosis of AECOPD readmission probability were 43.3%and 78.9%,respectively.The AUC of the prediction probability was 0.784,and the maximum Youden index was 0.487.At this time,the sensitivity and specificity of the probability of readmission for COPD exacerbation were 71.1% and 76.7%,respectively.Conclusions:1.COPD patients complicated with lower extremity venous thrombosis,pulmonary hypertension,coronary heart disease,pulmonary heart disease and respiratory failure are more likely to have acute exacerbation readmission.2.Decreased peripheral blood lymphocyte count and increased neutrophil/lymphocyte ratio were more likely to have acute exacerbation readmission.3.The correct and regular use of inhaled drugs in stable COPD can reduce the readmission of acute exacerbation.4.The worse lung function and the longer duration of oxygen therapy are independent risk factors for acute exacerbation readmission in COPD patients within 1 year.