作者：马玲，王志贤，罗兵

单位：

230041安徽省合肥市，安徽省第二人民医院医学检验中心

Units：

Department of Medical Laboratory Center, Anhui No.2 Provincial People's Hospital, Hefei 230041, China

关键词：

肺疾病，慢性阻塞性；慢性阻塞性肺疾病急性加重期；老年人；血红蛋白；清蛋白；淋巴细胞；血 小板；病人再入院；预测

Keywords：

Pulmonary disease, chronic obstructive; Acute exacerbation of chronic obstructive pulmonary disease; Aged; Hemoglobins; Albumins; Lymphocytes; Blood platelets; Patient readmission; Forecasting

CLC：

R 563.9

DOI：

10.12114/j.issn.1008-5971.2024.00.028

Funds：

安徽省教育厅高校科学研究重点项目（KJ2019A1099）

摘要：

　目的　探讨血红蛋白、清蛋白、淋巴细胞和血小板（HALP）指数对老年慢性阻塞性肺疾病急性加 重期（AECOPD）患者出院后30 d内非计划再入院的预测价值。方法　选取2019年5月—2023年7月安徽省第二人民医 院收治的122例老年AECOPD患者为研究对象，通过电子病历收集患者的临床资料，根据出院后 30 d内是否发生非计 划再入院将患者分为再入院组（ n=34）和非再入院组（n=88）。采用多因素Logistic回归分析探讨老年 AECOPD患者 出院后30 d内非计划再入院的影响因素；采用ROC曲线分析C反应蛋白（CRP）、HALP指数对老年AECOPD患者出院 后30 d内非计划再入院的预测价值。结果　两组CRP、清蛋白（ALB）、淋巴细胞计数、第1秒用力呼气容积占预计 值的百分比（FEV1%pred）、HALP指数比较，差异有统计学意义（P＜0.05）。多因素Logistic回归分析结果显示， CRP〔OR=2.594，95%CI（1.571～4.284）〕、HALP指数〔OR=0.822，95%CI（0.762～0.887）〕是老年AECOPD患者 出院后30 d内非计划再入院的独立影响因素（P＜0.05）。ROC曲线分析结果显示，CRP、HALP指数预测老年AECOPD 患者出院后30 d内非计划再入院的AUC分别为0.707〔95%CI（0.609～0.806）〕、0.843〔95%CI（0.779～0.907）〕， 最佳截断值分别为14.30 mg/L、35.50，灵敏度分别为76.19%、84.62%，特异度分别为58.73%、60.00%。结论　CRP、 HALP指数是老年AECOPD患者出院后30 d内非计划再入院的独立影响因素，HALP指数对老年AECOPD患者出院后30 d 内非计划再入院具有良好的预测效能，有助于临床尽早识别非计划再入院高风险的老年AECOPD患者。

Abstract：

Objective To explore the predictive value of hemoglobin, albumin, lymphocyte and platelet (HALP) index for unplanned readmission within 30 days after discharge in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) . Methods A total of 122 elderly patients with AECOPD admitted to Anhui No.2 Provincial People's Hospital from May 2019 to July 2023 were selected as research objects. The clinical data of the patients were collected through electronic medical records, and the patients were divided into readmission group ( n=34) and non-readmission group (n=88) according to whether unplanned readmission occurred within 30 days after discharge. Multivariate Logistic regression analysis was used to explore the influencing factors of unplanned readmission within 30 days after discharge in elderly patients with AECOPD. The ROC curve was used to explore the predictive value of the C reactive protein (CRP) and HALP index for unplanned readmission within 30 days after discharge in elderly patients with AECOPD. Results There were significant differences in CRP, albumin (ALB) , lymphocyte count, percentage of forced expiratory volume in one second to expected value (FEV1%pred) , HALP index between the two groups (P < 0.05) . Multivariate Logistic regression analysis showed that CRP [OR=2.594, 95%CI (1.571- 4.284) ] , HALP index [OR=0.822, 95%CI (0.762-0.887) ] were the independent influencing factors of unplanned readmission within 30 days after discharge in elderly patients with AECOPD (P < 0.05) . ROC curve analysis showed that the AUC of the CRP, HALP index for predicting unplanned readmission within 30 days after discharge in elderly patients with AECOPD were 0.707 [95%CI (0.609-0.806) ] , 0.843 [95%CI (0.779-0.907) ] , the optimal cut-off value were 14.30 mg/L, 35.50, the sensitivities were 76.19%, 84.62%, and specificities were 58.73%, 60.00%, respectively. Conclusion CRP, HALP index are the independent influencing factors of unplanned readmission within 30 days after discharge in elderly patients with AECOPD. HALP index has good predictive power for unplanned readmission within 30 days after discharge in elderly patients with AECOPD, which helps to identify elderly AECOPD patients with high-risk of unplanned readmission early in clinical practice.

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