ACCI及频繁住院对慢阻肺患者30天内再住院的预测价值

Predictive Value of ACCI and Frequent Hospitalisations for Rehospitalisation within 30 Days in Patients with COPD

摘要: 目的：本研究拟探讨ACCI及近1年内频繁住院对慢阻肺患者30天内再住院的影响。为了更有效地识别慢阻肺患者中的高危患者群体，本研究致力于寻找单一的或联合的预测指标。这些指标将帮助我们早期识别并干预那些可控的高危因素，从而优化患者的预后，减少再住院率和病死率，进而减轻社会和家庭的经济与精神负担。方法：选取2020年1月至2023年12月承德市中心医院收治的慢阻肺患者作为观察对象，根据是否30天内再住院分为再住院组和非再住院组，将30天内再住院的患者55例作为再住院组，将30天内未再住院的患者随机抽样51例作为对照组。使用Logistic回归评估患者30天内再住院的危险因素。结果：再住院组年龄、频繁住院高于非再住院患者。BMI、RDW、中性粒细胞计数、中性粒细胞百分比、NLR、NPAR、ALB、PNI、ACCI、ADL评分、PaO₂、首次住院天数、使用静脉抗生素天数低于非再住院患者。P值均小于0.05，差异有显著性。Logistic回归分析提示ACCI (OR = 2.293, 95%CI: 1.120~4.694, P < 0.05)、ADL评分(OR = 0.946, 95%CI: 0.898~0.997, P < 0.05)、近1年内频繁住院(OR = 0.065, 95%CI: 0.006~0.769, P < 0.05)是30天内再住院的独立危险因素。结论：ACCI、ADL评分和近1年内频繁住院是慢阻肺患者30天内再住院的独立危险因素。通过干预改善患者并发症及降低患者频繁住院次数，可减少患者再住院风险，对再住院的早期干预有一定的临床价值。

Abstract: Objective: This study intends to investigate the impact of ACCI and frequent hospitalisations within the last 1 year on readmissions within 30 days in patients with chronic obstructive pulmonary disease. In order to more effectively identify high-risk patient groups among patients with chronic obstructive pulmonary disease (COPD), this study is dedicated to finding single or combined predictive indicators. These indicators will help us to identify and intervene early on those controllable high-risk factors, thus optimising patient prognosis, reducing re-hospitalisation and morbidity and mortality, and in turn reducing the economic and emotional burden on society and families. Methods: Patients with chronic obstructive pulmonary disease admitted to Chengde City Central Hospital from January 2020 to December 2023 were selected as observation subjects, and were divided into rehospitalisation and non-rehospitalisation groups according to whether they had been rehospitalised within 30 days; 55 patients who had been rehospitalised within 30 days were treated as the rehospitalisation group, and 51 patients who had not been rehospitalised within 30 days were randomly sampled as the control group. Logistic regression was used to assess the risk factors for readmission of patients within 30 days. Results: Age and frequent hospitalisation were higher in the rehospitalisation group than in the non-rehospitalised patients. BMI, RDW, neutrophil count, neutrophil percentage, NLR, NPAR, ALB, PNI, ACCI, ADL scores, PaO₂, number of days to first hospitalisation, number of days on intravenous antibiotics were lower than in the non-rehospitalised patients. The P-value was less than 0.05 and the difference was significant. Logistic regression analysis suggested that ACCI (OR = 2.293, 95% CI: 1.120~4.694, P < 0.05), ADL score (OR = 0.946, 95% CI: 0.898~0.997, P < 0.05), and frequent hospitalisation in the last 1 year (OR = 0.065, 95% CI: 0.006~0.769, P < 0.05) were independent risk factors for rehospitalisation within 30 days. Conclusion: ACCI, ADL score and frequent hospitalisation in the last 1 year were independent risk factors for re-hospitalisation within 30 days in patients with chronic obstructive pulmonary disease. Intervention to improve patients’ complications and reduce the number of frequent hospitalisations can reduce the risk of rehospitalisation and has some clinical value in early intervention for rehospitalisation.