Multivariate Analysis Of One-year Readmission In Elderly Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Objective:Through the study of risk factors related to readmission in elderly patients with AECOPD within one year,the purpose of this study was to find out the related factors affecting readmission and to provide evidence for clinical intervention.Methods:1.From June 2017 to December 2018,212 elderly AECOPD patients hospitalized in the respiratory department of Shaanxi Provincial people's Hospital were collected,and the clinical case data of all patients were collected.If the patient has multiple hospitalization history in one year,The data of the patients who were hospitalized for the first time in one year were collected for analysis.2.The clinical data of 212 patients were divided into readmission group?133 cases?and control group?79 cases?.Readmission group:the patient has a history of AECOPD within 1 year before admission and leads to hospitalization?or a history of AECOPD within1 year of hospitalization?.Control group:the patient had no history of AECOPD or AECOPD within 1 year before admission but did not lead to hospitalization?and there was no history of AECOPD within 1 year after admission or no hospitalization even if there was a history of AECOPD?.3.31 patients were randomly selected from 212 patients for evaluation and questionnaire investigation.According to the history of acute aggravation hospitalization within 1 year,they were divided into group A?15cases?and group B?16 cases?with AWCOPD hospitalization history within 1 year.Group B had no history of hospitalization of AECOPD within 1 year.4.Case data were collected from all subjects,including gender,age,height,body mass index?BMI?,duration of disease,complications,acute exacerbations within 1 year,smoking index,Procalcitonin?PCT?,C-reactive protein?CRP?,erythrocyte sedimentation rate,sputum bacterial culture,blood routine test,liver function,renal function ion,blood gas analysis,blood lipid,coagulation and fibrinolysis,BNP,pulmonary function test and early systemic glucocorticoid use,etc.5.The questionnaire included whether the inhaled drugs were incorrect,whether there was a history of lung rehabilitation education,whether there was a history of influenza vaccine and/or Streptococcus pneumoniae vaccination,and a dyspnea index score?mMRC score?.Patients with chronic obstructive pulmonary disease?CAT?,simple nutritional evaluation scale?MNA-SF?,venous thromboembolism risk?VTE?evaluation and so on.6.The test data was analyzed with the SPSS 19.0 software and the number of data used?constituent ratio?was expressed.The inter-group comparisons of the count data were tested with a chi-square.The mean square standard deviation??X±s?of the measurement data in accordance with the normal distribution indicated that the difference between the two groups was compared with the t-test;the median?range?expression of the measurement data which did not meet the normal distribution indicated that the difference between the two groups was compared with the non-standard test.a logistic regression analysis to assess the risk of re-admission in the aged AECOPD patients for 1 year.Results:1.The difference of clinical data between the re-admission group and the control group:the average age in the re-admission group was significantly higher than that in the control group?P<0.05?,and the FEV₁/FVC value in the re-admission group was significantly lower than that in the control group?P<0.05?.The proportion of patients with cor pulmonale in the re-admission group was significantly higher than that in the control group?P<0.05?.The ratio of WBC and Neutrophil in the readmission group was significantly higher than that in the control group?P<0.05?.The use of systemic corticosteroids was statistically significant in the difference between the two groups?P<0.05?.The monocyte ratio,eosinophils ratio,phosphorus,fasting blood glucose,activated partial thromboplastin time and Fibrinogen?Fg?in the readmission group were significantly higher than those in the control group?P<0.05?.2.Single-factor logistic regression analysis was performed on the clinical data of the readmission group and the control group.The results showed that the age was>75 years,FEV₁/FVC<60%,concurrent pulmonary heart disease,white blood cell count>7×10⁹/L,neutrophil ratio>0.7,and monocyte ratio>0.08,The fasting blood glucose>6.1 mmol/L was the risk factor?OR>1?for the elderly AECOPD patients to be admitted to the hospital for 1 year.Early acceptance of systemic glucocorticoid reduced the readmission rate of elderly AECOPD within 1 year?OR<1?.3.After adjusting for risk factors associated with Age,FEV₁/FVC,WBC,NEU,MONO,Blood sugar,systemic use of corticosteroids,The risk of re-admission within one year in elderly AECOPD patients with corpulmonale was 57.011 times higher than that in AECOPD patients without corpulmonale.Therefore,corpulmonale was an independent risk factor for re-admission of AECOPD in the elderly within one year.4.The difference between group A and group B was as follows:the number of mMRC?3 in group A was significantly higher than that in group B?P<0.05?.The score of CAT in group A was significantly higher than that in group b?P<0.05?.There was significant difference in VTE score between the two groups.5.Univariate logistic regression analysis showed that mMRC?3,CAT?22 and VTE?3 were the risk factors for re-admission in elderly patients with AECOPD within 1 year.6.After correcting the risk factors related to readmission,such as mMRC?3,CAT?22,VTE?3,The risk of readmission within one year in elderly AECOPD patients with VTE?3 score was 30.533 times higher than that in elderly AECOPD patients with VTE<3score.VTE?3 score was an independent risk factor for elderly AECOPD patients to readmission within one year.Conclusion:1.Age>75 years old,FEV₁/FVC<60%,complicated with corpulmonale,white blood cell count>7.0×10⁹/L,neutrophil ratio>0.7,monocyte ratio>0.08,fasting blood glucose>6.1mmol/L,mMRC?3,CAT?22 and VTE?3 were the risk factors for re-admission of AECOPD in the elderly within one year.Complicated with corpulmonale and VTE?3 are independent risk factors for re-admission within 1 year in elderly patients with AECOPD,which may lead to an increase in the number of readmissions within 1 year in elderly patients with AECOPD.2.Early acceptance of systemic glucocorticoid in AECOPD patients can reduce the readmission rate of elderly AECOPD patients within 1 year.