Construction of Nomogram prediction model for risk of pulmonary thromboembolism in elderly patients with acute exacerbation of chronic obstructive pulmonary disease
DING Liumin1 WU Chao2 ZHANG Xiumin1 XIA Yu3▲
1.Department of Nursing, Xinjiang Uygur Autonomous Region People’s Hospital, Xinjiang Uygur Autonomous Region, Urumqi 830000, China;
2.Center for Respiratory and Critical Care Medicine, Xinjiang Uygur Autonomous Region People’s Hospital, Xinjiang Uygur Autonomous Region, Urumqi 830000, China;
3.the Second Department of Pneumology, the First Affiliated Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi 830054, China
Abstract：Objective To analyze the risk factors of pulmonary thromboembolism (PTE) in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and construct a Nomogram risk warning model. Methods A retrospective analysis of 265 elderly patients with AECOPD admitted to Xinjiang Uygur Autonomous Region People’s Hospital from January 2019 to June 2021 were conducted, they were divided into PTE group and non-PTE group according to whether PTE occurred. General data, laboratory indicators, and underlying diseases of two groups were collected, and the risk factors of PTE in elderly AECOPD patients were analyzed; the Nomogram risk model to predict the risk of PTE in elderly patients with AECOPD based on the risk factors and its predictive efficacy was verified. Results Among 265 elderly patients with AECOPD, the incidence of PTE was 20.38%. There were no significant differences in gender, body mass index, drinking history, smoking history, hypertension, diabetes mellitus, cerebrovascular disease, coronary heart disease, atrial fibrillation, hemoglobin, and white blood cell count between two groups (P＞0.05); there were statistically significant differences in age, history of venous thrombosis, lower limb swelling, lower limb pain, fever time, bed time, D-dimer (D-D), arterial partial pressure of carbon dioxide (PaCO2), and arterial partial pressure of oxygen (PaO2) between two groups (P＜0.05). Age＞69 years old (OR=3.205), history of venous thrombosis (OR=4.035), lower limb swelling (OR=3.149), lower limb pain (OR=8.193), fever time≥3 d (OR=2.323), bed time ≥7 d (OR=3.451), D-D≥200 μg/L (OR=2.426), PaCO2＜60 mmHg (OR=3.786), and PaO2＜39 mmHg (OR=2.860) were independent risk factors for PTE in elderly patients with AECOPD (P＜0.05). The equation was Y=-4.780+1.165×age+1.395×history of venous thrombosis +1.147×lower limb swelling+2.103×lower limb pain+0.843×fever time +1.239×bed time + 0.886×D-D+1.331×PaCO2+1.051×PaO2. The Nomogram prediction model to predict the risk of PTE in elderly patients with AECOPD showed that the model consistency index was 0.862; the area under the curve of receiver operating characteristic curve of the model was 0.851. Conclusion Age, history of venous thrombosis, lower extremity swelling, lower extremity pain, fever time, bed time, D-D, PaCO2, and PaO2 are closely related to the occurrence of PTE in elderly AECOPD patients. The Nomogram prediction model based on these risk factors can effectively predict the risk of PTE in elderly patients with AECOPD.
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