Hakim Maryam A, Garden Frances L, Jennings Matthew D, Dobler Claudia C
Department of Respiratory Medicine, Liverpool Hospital.
South Western Sydney Clinical School, University of New South Wales.
Clin Epidemiol. 2017 Dec 27;10:51-59. doi: 10.2147/CLEP.S149574. eCollection 2018.
Patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (COPD) have a high 30-day hospital readmission rate, which has a large impact on the health care system and patients' quality of life. The use of a prediction model to quantify a patient's risk of readmission may assist in directing interventions to patients who will benefit most. The objective of this study was to calculate the rate of 30-day readmissions and evaluate the accuracy of the LACE index (length of stay, acuity of admission, co-morbidities, and emergency department visits within the last 6 months) for 30-day readmissions in a general hospital population of COPD patients.
All patients admitted with a principal diagnosis of COPD to Liverpool Hospital, a tertiary hospital in Sydney, Australia, between 2006 and 2016 were included in the study. A LACE index score was calculated for each patient and assessed using receiver operator characteristic curves.
During the study period, 2,662 patients had 5,979 hospitalizations for COPD. Four percent of patients died in hospital and 25% were readmitted within 30 days; 56% of all 30-day readmissions were again due to COPD. The most common reasons for readmission, following COPD, were heart failure, pneumonia, and chest pain. The LACE index had moderate discriminative ability to predict 30-day readmission (-statistic =0.63).
The 30-day hospital readmission rate was 25% following hospitalization for COPD in an Australian tertiary hospital and as such comparable to international published rates. The LACE index only had moderate discriminative ability to predict 30-day readmission in patients hospitalized for COPD.
因慢性阻塞性肺疾病（COPD）急性加重而住院的患者30天再入院率较高，这对医疗保健系统和患者生活质量有很大影响。使用预测模型量化患者再入院风险可能有助于将干预措施指向受益最大的患者。本研究的目的是计算30天再入院率，并评估LACE指数（住院时间、入院急症程度、合并症以及过去6个月内的急诊科就诊次数）对综合医院COPD患者群体30天再入院情况的预测准确性。
纳入2006年至2016年期间在澳大利亚悉尼一家三级医院利物浦医院因COPD为主诊断入院的所有患者。为每位患者计算LACE指数评分，并使用受试者工作特征曲线进行评估。
在研究期间，2662例患者因COPD住院5979次。4%的患者在医院死亡，25%在30天内再次入院；所有30天再入院患者中56%再次因COPD入院。COPD之后，再入院的最常见原因是心力衰竭、肺炎和胸痛。LACE指数预测30天再入院的判别能力中等（统计量=0.63）。
在澳大利亚一家三级医院，COPD住院后30天再入院率为25%，与国际公布的率相当。LACE指数对因COPD住院患者30天再入院的预测判别能力仅为中等。
