Risk Factors of Readmission Within 90 Days for Chronic Obstructive Pulmonary Disease Patients with Frailty and Construction of an Early Warning Model

Abstract

Objective

This study aimed to explore the risk factors for readmission within 90 d in Chronic Obstructive Pulmonary Disease (COPD) patients with frailty and construct a clinical warning model.

Methods

COPD patients with frailty hospitalized in the Department of Respiratory and Critical Care Medicine of Yixing Hospital, Affiliated to Jiangsu University, were retrospectively collected from January 1, 2020, to June 30, 2022. Patients were divided into readmission and control groups according to readmission within 90 d. The clinical data of the two groups were evaluated by univariate and multivariate logistic regression analyses to identify readmission risk factors within 90 d in COPD patients with frailty. Then, a risk quantitative early warning model was constructed. Finally, the model’s prediction efficiency was evaluated, and external verification was carried out.

Results

The multivariate logistic regression analysis showed that BMI, number of hospitalizations in the past year ≥ 2, CCI, REFS, and 4MGS were independent risk factors for readmission within 90 d in COPD patients with frailty. The early warning model for these patients was established as follows: Logit (p) = −1.896 + (−0.166 × BMI) + (0.969 × number of hospitalizations in the past year ≥ 2) + (0.265 × CCI) + (0.405 × REFS) + (−3.209 × 4MGS), and presented an area under the ROC curve (AUC) of 0.744 [95% CI: 0.687–0.801]. The AUC of the external validation cohort was 0.737 (95% CI: 0.648–0.826), and the AUC of the LACE warning model was 0.657 (95% CI:0.552–0.762).

Conclusion

The BMI, number of hospitalizations in the past year ≥ 2, CCI, REFS, and 4MGS were independent risk factors for readmission within 90 d in COPD patients with frailty. The early warning model presented a moderate predictive value for assessing the risk of readmission within 90 d in these patients.

Keywords:

• chronic obstructive pulmonary disease
• frailty
• readmission
• risk factors
• warning model

Abbreviations

COPD, Chronic Obstructive Pulmonary Disease; mMRC, Modified British Medical Research Council questionnaire; CAT, Chronic Obstructive Pulmonary Disease assessment test score; CCI, Charlson comorbidity index; REFS, The Reported Edmonton Frail Scale; FEV1, first second forced expiratory volume; FVC, forced vital capacity; BMI, Body mass index; 4MGS, 4 meters gait speed; WBC, white blood cell count; hs-CRP, high-sensitive C-reactive protein; ESR, erythrocyte sedimentation rate; Scr: endogenous creatinine; BUN, blood urea nitrogen; ALB, serum albumin; ROC curve, receiver operating characteristic curve; AUC, area under the curve.

Data Sharing Statement

The dataset in this study can be obtained with the corresponding author under reasonable requirements. However, these data cannot be disclosed due to privacy and moral constraints.

Ethics Approval and Consent to Participate

This study was approved by the Ethics Committee of the People’s Hospital of Yixing City, Jiangsu Province (batch number: 2022 Wen 082), and all the subjects signed the informed consent form.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was partially supported by the National Natural Science Foundation of China (81802102) and the Young Top Talents of Wuxi Health Commission (grant no. BJ2020107).