Abstract:

Objective　To investigate the factors contributing to nutritional risk in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to construct and validate a corresponding nomogram. Methods　A retrospective analysis was conducted on 300 AECOPD patients admitted to Chang'an Hospital between June 2021 and June 2023, who were divided into a training set (210 cases) and a validation set (90 cases) in a 7:3 ratio using random numbers generated by computer. The training set was further categorized into groups with (83 cases) or without (127 cases) nutritional risk. General data of the two groups were compared, and a multivariate logistic regression model was applied to identify the factors influencing nutritional risk in AECOPD patients. A regression equation and a nomogram were subsequently constructed. The model's predictive efficiency was assessed internally using the receiver operating characteristic curve (ROC), and the calibration curve and decision curve analysis (DCA) were used to evaluate the model's calibration accuracy and clinical utility. χ² test, t test, and Mann-Whitney U test were used for statistical analysis. Results　Multivariate logistic regression model showed that diabetes mellitus (OR=2.861, 95%CI 1.407-5.818), dietary imbalance (OR=2.985, 95%CI 1.401-6.358), COPD Assessment Test (CAT) score (OR=2.163, 95%CI 1.436-3.258), and multiple drug resistance (OR=2.051, 95%CI 1.075-3.912) were risk factors for nutritional risk in AECOPD patients (all P<0.05); Perceptive Social Support Scale (PSSS) score (OR=0.496, 95%CI 0.252-0.977) and albumin (Alb, OR=0.524, 95%CI 0.341-0.805) were protective factors (all P<0.05).  Based on the logistic regression analysis of the training set, a nomogram model was constructed to predict nutritional risk in AECOPD patients. The area under the curve (AUC) of the nomogram model for predicting nutritional risk was 0.945  for the training set, with a sensitivity of 91.57% and a specificity of 91.34%; for the validation set, the AUC was 0.909 , with a sensitivity of 86.11% and a specificity of 94.44%. The Hosmer-Lemeshow test revealed no statistically significant difference in the calibration curve for both training set (χ²=0.512, P>0.05) and validation set (χ²=0.633, P>0.05). Internal validation using the Bootstrap method showed that the concordance index (C-index) was 0.932 for the training set and 0.908 for the validation set. The decision curve showed that the training set and the validation set obtained clinical net benefit in the range of risk threshold 0.16-0.80 and 0.45-0.83, respectively. Conclusions　Diabetes mellitus, dietary imbalance, multidrug resistance, and CAT score are risk factors for nutritional risk in AECOPD patients, while PSSS score and Alb level serve as protective factors. The nomogram model based on these factors exhibits robust clinical utility and predictive accuracy.

Key words:

Acute exacerbation of chronic obstructive pulmonary disease, Nutritional risk, Risk factors, Nomogram

摘要：

目的　分析慢性阻塞性肺疾病急性加重期（AECOPD）患者的营养风险影响因素，建立对应的列线图模型并进行效能验证。方法　采用回顾性研究，选取2021年6月至2023年6月长安医院收治的AECOPD患者300例，经计算机产生随机数表，以7∶3将其分为学习集（210例）、检验集（90例）。根据学习集患者是否存在营养风险将其分为营养风险组（83例）、无营养风险组（127例）。比较两组一般资料，采用多因素logistic回归模型筛选出AECOPD患者存在营养风险的影响因素，建立回归方程及列线图模型；用受试者操作特征曲线（ROC）对模型的预测效能进行内部评价；用校准曲线、决策曲线评价模型的校准能力、临床净获益。统计学方法采用χ²检验、t检验、Mann-Whitney U检验。结果　多因素logistic回归模型显示，合并糖尿病（OR=2.861，95%CI 1.407～5.818）、膳食结构失衡（OR=2.985，95%CI 1.401～6.358）、COPD评估测试（CAT）评分（OR=2.163，95%CI 1.436～3.258）、多重耐药（OR=2.051，95%CI 1.075～3.912）均是AECOPD患者存在营养风险的危险因素（均P<0.05）；领悟社会支持量表（PSSS）评分（OR=0.496，95%CI 0.252～0.977）、白蛋白（Alb，OR=0.524，95%CI 0.341～0.805）均是保护因素（均P<0.05）。列线图模型预测学习集营养风险的曲线下面积（AUC）为0.945，灵敏度为91.57%，特异度为91.34%；预测检验集营养风险的AUC为0.909，灵敏度为86.11%，特异度为94.44%。学习集、检验集的校准曲线经Hosmer-Lemeshow检验，差异均无统计学意义（χ²=0.512、0.633，均P>0.05）。Bootstrap法内部验证结果显示，学习集、检验集的一致性指数（C-index）指数分别为0.932、0.908；决策曲线显示，学习集、检验集分别在风险阈值0.16～0.80、0.45～0.83范围内获取临床净收益。结论　合并糖尿病、膳食结构失衡、多重耐药、CAT评分均是AECOPD患者存在营养风险的危险因素，PSSS评分、Alb是保护因素，据此建立的列线图模型具有良好临床效能。

关键词:

慢性阻塞性肺疾病急性加重期, 营养风险, 影响因素, 列线图