Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan 121#, Gulou District, Nanjing, 210000, Jiangsu, China.
BMC Pulm Med. 2021 Oct 15;21(1):320. doi: 10.1186/s12890-021-01692-3.
BACKGROUND: To investigate the risk factors and construct a logistic model and an extreme gradient boosting (XGBoost) model to compare the predictive performances for readmission in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients within one year. METHODS: In total, 636 patients with AECOPD were recruited and divided into readmission group (n = 449) and non-readmission group (n = 187). Backward stepwise regression method was used to analyze the risk factors for readmission. Data were divided into training set and testing set at a ratio of 7:3. Variables with statistical significance were included in the logistic model and variables with P < 0.1 were included in the XGBoost model, and receiver operator characteristic (ROC) curves were plotted. RESULTS: Patients with acute exacerbations within the previous 1 year [odds ratio (OR) = 4.086, 95% confidence interval (CI) 2.723-6.133, P < 0.001), long-acting β agonist (LABA) application (OR = 4.550, 95% CI 1.587-13.042, P = 0.005), inhaled corticosteroids (ICS) application (OR = 0.227, 95% CI 0.076-0.672, P = 0.007), glutamic-pyruvic transaminase (ALT) level (OR = 0.985, 95% CI 0.971-0.999, P = 0.042), and total CAT score (OR = 1.091, 95% CI 1.048-1.136, P < 0.001) were associated with the risk of readmission. The AUC value of the logistic model was 0.743 (95% CI 0.692-0.795) in the training set and 0.699 (95% CI 0.617-0.780) in the testing set. The AUC value of XGBoost model was 0.814 (95% CI 0.812-0.815) in the training set and 0.722 (95% CI 0.720-0.725) in the testing set. CONCLUSIONS: The XGBoost model showed a better predictive value in predicting the risk of readmission within one year in the AECOPD patients than the logistic regression model. The findings of our study might help identify patients with a high risk of readmission within one year and provide timely treatment to prevent the reoccurrence of AECOPD.
背景:本研究旨在探讨慢性阻塞性肺疾病急性加重(AECOPD)患者在一年内再次入院的风险因素,并构建逻辑回归(logistic)模型和极端梯度提升(XGBoost)模型来比较预测性能。
方法:共纳入 636 例 AECOPD 患者,根据是否在 1 年内再次入院分为再入院组(n=449)和非再入院组(n=187)。采用后退逐步回归方法分析再入院的风险因素。将数据分为训练集和测试集,比例为 7:3。将有统计学意义的变量纳入逻辑回归模型,将 P<0.1 的变量纳入 XGBoost 模型,并绘制受试者工作特征(ROC)曲线。
结果:在过去 1 年内急性加重的患者(比值比[OR] = 4.086,95%置信区间[CI] 2.723-6.133,P<0.001)、长效β受体激动剂(LABA)应用(OR = 4.550,95% CI 1.587-13.042,P=0.005)、吸入性糖皮质激素(ICS)应用(OR = 0.227,95% CI 0.076-0.672,P=0.007)、谷草转氨酶(ALT)水平(OR = 0.985,95% CI 0.971-0.999,P=0.042)和总 CAT 评分(OR = 1.091,95% CI 1.048-1.136,P<0.001)与再入院风险相关。逻辑回归模型在训练集的 AUC 值为 0.743(95% CI 0.692-0.795),在测试集的 AUC 值为 0.699(95% CI 0.617-0.780)。XGBoost 模型在训练集的 AUC 值为 0.814(95% CI 0.812-0.815),在测试集的 AUC 值为 0.722(95% CI 0.720-0.725)。
结论:与逻辑回归模型相比,XGBoost 模型在预测 AECOPD 患者一年内再入院风险方面具有更好的预测价值。本研究的结果可能有助于识别出一年内有高再入院风险的患者,并及时进行治疗,以防止 AECOPD 的再次发生。
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