慢性阻塞性肺疾病急性加重期患者合并应激性高血糖风险预测模型构建研究

doi:10.3761/j.issn.2096-7446.2024.12.001

摘要/Abstract

摘要： 目的探讨慢性阻塞性肺疾病急性加重期（acute-exacerbations of chronic obstructive pulmonary disease,AECOPD）患者发生应激性高血糖的影响因素,并构建风险预测列线图模型。方法回顾性选取2021年3月—2023年3月乌鲁木齐市某三级甲等医院急诊重症监护室收治的444例AECOPD患者作为调查对象。采用单因素分析和Logistic回归分析确定AECOPD发生应激性高血糖的危险因素,建立风险预测模型并绘制列线图。采用受试者工作特征曲线检测模型的预测效果,Hosmer-Lemeshow检验判断模型的拟合优度。结果 AECOPD患者应激性高血糖发生率为24.5%。Logistic回归分析结果显示,年龄、吸烟、脑血管疾病史、机械通气、入院时急性生理与慢性健康状况Ⅱ评分、血糖变异系数、C-反应蛋白是AECOPD患者发生应激性高血糖的独立影响因素（P<0.05）。基于Logistic回归建立个体化列线图预测模型,受试者操作特征曲线面积为0.823（95%CI：0.780~0.865）,Hosmer-Lemeshow检验P=0.354,最佳截断值为0.514,灵敏度为0.872,特异度为0.642。Bootstrap自助法进行内部验证的结果显示,C指数为0.817,提示模型预测效果良好。结论该研究构建的预测模型预测效果较好,可为临床有效评估AECOPD患者应激性高血糖发生风险提供参考依据。

关键词: 慢性阻塞性肺疾病急性加重期, 应激性高血糖, 影响因素分析, 列线图, 护理

Abstract: Objective To explore the influencing factors of stress hyperglycemia in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）,and to construct a risk prediction nomogram model. Methods A retrospective study was conducted among 444 AECOPD patients in the emergency intensive care of a tertiary class A hospital in Urumqi from March 2021 to March 2023,and the independent risk factors of stress hyperglycemia in AECOPD patients were explored through univariate analysis and Logistic regression analysis. A risk prediction model was established and incorporated into the nomogram. The prediction performance of the model was tested using the receiver operating characteristic curve（ROC）,and the Hosmer-Lemeshow test was used to determine the goodness of fit of the model. Results The incidence of stress hyperglycemia in AECOPD patients was 24.5%. Logistic regression analysis showed that age,smoking,history of cerebrovascular disease,mechanical ventilation,Acute Physiology and Chronic Health EvaluationⅡ score at admission,coefficient of variation of blood glucose and C-reactive protein were independent influencing factors for stress hyperglycemia in AECOPD patients（P<0.05）. The individual nomogram prediction model was established based on Logistic regression. The area under the receiver operating characteristic curve was 0.823（95%CI：0.780~0.865）,the Hosmer-Lemeshow test P=0.354,the best cutoff value was 0.514,the sensitivity was 0.872,and the specificity was 0.642. The Bootstrap method was used for internal validation,and the C-index was 0.817,indicating that the model had a good prediction effect. Results The prediction model constructed in this study has a good prediction effect,which can provide a reference for effectively evaluating the risk of stress hyperglycemia in patients with AECOPD.

Key words: Acute Exacerbation of Chronic Obstructive Pulmonary Disease, Stress Hyperglycemia, Root Cause Analysis, Nomogram, Nurse Care

谢云, 罗莉, 王海燕. 慢性阻塞性肺疾病急性加重期患者合并应激性高血糖风险预测模型构建研究[J]. 中华急危重症护理杂志, 2024, 5(12): 1061-1067.

XIE Yun, LUO Li, WANG Haiyan. The development of a risk prediction model for stress hyperglycemia in patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(12): 1061-1067.

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