Risk factors and predictive model for weaning failure in elderly patients with chronic obstructive pulmonary disease and type II respiratory failure.

OBJECTIVE

To identify factors associated with failed weaning from mechanical ventilation in elderly patients with chronic obstructive pulmonary disease (COPD) and type II respiratory failure.

METHOD

This retrospective study included 210 patients treated at the Fourth Affiliated Hospital of Soochow University from April 2021 to April 2024. Patients were divided into a modeling group (n = 147) and a validation group (n = 63) in a 7:3 ratio. Univariate and multivariate logistic regression analyses were performed to determine risk factors for weaning failure. A risk prediction model was developed based on the multivariate results using the glm function and visualized as a nomogram with the rms package. The model's predictive performance was evaluated using receiver operating characteristic (ROC) curves.

RESULTS

Multivariate analysis identified elevated N-terminal pro-brain natriuretic peptide (NT-proBNP), low 25-hydroxyvitamin D [25(OH)D], high rapid shallow breathing index, longer COPD disease duration, and higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores as independent risk factors (all P < 0.05). The area under the ROC curve (AUC) for predicting weaning failure was 0.802 in the modeling group and 0.824 in the validation group, indicating good predictive accuracy.

CONCLUSION

NT-proBNP, 25(OH)D, rapid shallow breathing index, COPD duration, and APACHE II score are key predictors of mechanical ventilation weaning failure in elderly COPD patients with type II respiratory failure. The developed model demonstrates robust predictive value and may aid clinical decision-making.