| Objectiveto develop and validate a clinical model to predict the hospital outcome of AECOPD,and to summarize and analyze the Traditional Chinese Medicine(TCM)syndromes of 1767 cases with AECOPD.Methods1767 cases of AECOPD patients admitted to the respiratory department and intensive care unit of Guangdong hospital of traditional Chinese medicine on January 1,2016 and June 30,2019 were retrospectively analyzed,the data were randomly divided into training set and validation set at a ratio of 7:3.The training set was used to develop the model,and the verification set was used for external verification of the model.Univariate analysis and multivariate stepwise logistic regression analysis were carried out,and variables were selected based on the clinical situation,and logistic regression method was used to establish the model..The model was verified by operating characteristic curve(ROC)and area under the curve(AUC),and its calibration accuracy was evaluated by drawing calibration curve and calculating Brier score.ResultsA total of 133 cases died in the hospital.The training set included 1234 cases,the validation set included 533 cases,the univariate analysis and multi-factor stepwise logistic regression analysis results suggest that chronic heart failure,lung tumor,D-dimer,PaCO2,lactate,white blood cells and red blood cells,platelets,serum albumin,BMI,C-reactive protein and urea nitrogen are independent risk factors for COPD exacerbations in-hospital death.In combination with the clinical application,the promotion and application of the model and the difficulty in obtaining the independent variables,eight variables including age,chronic heart failure,lung tumor,PaCO2,lactate,white blood cells,red blood cells and platelets were finally determined as the parameter variables of the model.After constructing the model,the equation was as follows:probability of death outcome P=eY/(1+eY),Y=0.037×(age)+ 1.9171×(chronic heart failure)+2.6403×(lung tumor)+0.0498×(PaC02)+0.6484×(lactate)+0.22×(white blood cells)-1.9094 ×(red blood cells)-0.0109 X(platelets)-3.1732.During the model validation,the AUC in the training set was 0.9822(P<0.01),and the AUC in the validation set was 0.9657(P<0.01),showing a good degree of differentiation.The calibration curve of the model indicated that the curve of the model basically coincides with the 45°line,and the Brier score in the training set is 0.022,while the Brier score in the verification set is 0.023,indicating that the model has high accuracy..Among the 1,767 cases,the five most widely distributed syndromes were 443 cases(25.1%)of lung-spleen-kidney deficiency and turbid phlegm obstructing lung syndrome,381 cases(21.6%)of lung-spleen-kidney deficiency and phlegm-heat obstructing lung syndrome,289 cases(16.4%)of lung-spleen-kidney deficiency and phlegm-heat-blood stasis resistance syndrome,230 cases(13.0%)of the lung-spleen deficiency and phlegm-heat obstructs the lung syndrome,and 197 cases(11.1%)of lung-spleen deficiency and lung phlegm turbidity resistance syndrome.Among the 13 common TCM syndrome types,the death rate of each syndrome type was statistically analyzed,and the results showed that the death rate of qi-deficiency,blood-stasis and water-stasis syndrome(71.4%)was higher than that of other syndrome types.The death rates of the three syndromes of turbid phlegm syndrome(8.3%),phlegm fever syndrome(4.7%)and phlegm stasis syndrome(6.9%)were basically the same.ConclusionAccording to the predictors related to AECOPD hospital outcomes,we constructed a clinical prognosis model,which included 8 variables including age,chronic heart failure,pulmonary malignancy,PaCO2,lactate,white blood cells,red blood cells and platelets,the model shows good differentiation and accuracy in both internal and external validation,which can help clinicians predict the probability of hospital death of individual AECOPD patients,identify patients with poor prognosis in the early stage. |
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