Development and validation of a nomogram model for predicting one-year unplanned readmission in patients with chronic obstructive pulmonary disease.

OBJECTIVE

The aim of this study was to investigate the influencing factors of unplanned readmission in patients with chronic obstructive pulmonary disease (COPD) within 1 year after discharge, construct a risk prediction model and evaluate its effect.

METHODS

In this prospective study, we included 719 individuals diagnosed with COPD, identify optimal predictors of unplanned readmission and developed a nomogram prediction model. The model's performance was assessed through receiver operator characteristic curves, calibration plots, and decision curve analysis.

RESULTS

Of 607 patients included in the final analysis, the incidence of readmission within one year was 40.0%. Multivariate regression analysis identified several risk factors for readmission: white blood cell count (WBC; OR = 1.07, 95% CI = 1.03-1.12, P = 0.002), disease duration over 10 years (OR = 1.36, 95% CI = 0.75-2.462, P = 0.043), the number of acute exacerbation in the past 1 year (OR = 1.12, 95% CI = 1.05-1.20, P = 0.001), and concurrent respiratory failure (OR = 1.50, 95% CI = 0.97-2.33, P = 0.047). The nomogram model based on these factors exhibited an AUC of 0.719 in the model group and 0.676 in the validation group. The calibration curve showed a good degree of fit, and the Hosmer-Lemeshow test confirmed no significant deviations in model fit (P > 0.05). The clinical decision curve demonstrated that both the model and the validation groups provided better net benefits than the treat-all tactics or the treat-none tactics with threshold probability values of 0.25-0.95 and 0.25-0.85.

CONCLUSION

The developed model, integrating WBC count, disease duration, number of acute exacerbations within the past year and concurrent respiratory failure, effectively predicts the risk of one-year unplanned readmission in patients with COPD.