Construction and Validation of a Nomogram for Predicting the Risk of Delirium in Patients with Acute Exacerbation of COPD Complicated by Respiratory Failure

Yushan TANG; Liuhui ZHANG; Yang WAN

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Yushan TANG, Liuhui ZHANG, Yang WAN. Construction and Validation of a Nomogram for Predicting the Risk of Delirium in Patients with Acute Exacerbation of COPD Complicated by Respiratory Failure[J]. Journal of Kunming Medical University.

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Construction and Validation of a Nomogram for Predicting the Risk of Delirium in Patients with Acute Exacerbation of COPD Complicated by Respiratory Failure

Emergency Observation Room，The First Affiliated Hospital of Anhui Medical University，Hefei Anhui 230000，China

Received Date: 2026-01-07
Available Online: 2026-06-09

Abstract

Abstract

Objective To explore the influencing factors of delirium in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） complicated by respiratory failure, and to construct a nomogram prediction model, and to evaluate the predictive efficacy of this model. Methods A retrospective analysis was conducted on clinical data from 210 patients with AECOPD complicated by respiratory failure admitted to the First Affiliated Hospital of Anhui Medical University from March 2023 to March 2025, serving as the observation cohort. Patients were stratified into a delirium group （n = 72） and a non-delirium group （n = 138） based on whether delirium occurred. General baseline data of the two groups were compared, and univariate and multivariate Logistic regression analyses were conducted to explore the influencing factors of delirium in patients with AECOPD with respiratory failure. With delirium occurrence designated as positive and absence of delirium as negative, receiver operating characteristic （ROC） curves were plotted to analyze the predictive value of factors with significant differences in univariate analysis for delirium development. A nomogram model was constructed to predict the risk of delirium in AECOPD patients with respiratory failure, and the predictive performance was analyzed. Results Between the two groups, significant differences were observed in mechanical ventilation duration, arterial partial pressure of oxygen （PaO₂）, partial pressure of carbon dioxide （PaCO₂）, serum brain-derived neurotrophic factor （BDNF）, albumin （ALB）, C-reactive protein （CRP）, and microRNA-212-5p （miR-212-5p） levels （P < 0.001）. Multivariate Logistic regression analysis showed that mechanical ventilation duration > 72 hours （OR = 1.082, 95%CI: 1.016 ～1.152, P = 0.014）, serum BDNF ≤ 0.64 μg/L （OR = 0.922, 95%CI: 0.859～0.99, P = 0.024）, ALB ≤ 35 g/L （OR = 0.920, 95%CI: 0.875～0.968, P = 0.001）, miR-212-5p relative expression≤ 0.27 （OR = 0.927, 95%CI: 0.869～0.989, P = 0.021）, and serum CRP > 76.95 mg/L （OR = 1.081, 95%CI: 1.023～1.142, P = 0.005） were all independent risk factors for delirium in AECOPD patients with respiratory failure. ROC curve results showed that mechanical ventilation duration, serum BDNF, ALB, CRP, and miR-212-5p levels had AUCs of 0.807 （0.745～0.859）, 0.841 （0.783～0.889）, 0.793 （0.730～0.847）, 0.745 （0.61～ 0.803）, and 0.826 （0.768～0.875）, respectively, all demonstrating high predictive value. Further analysis of the ROC curve revealed that the nomogram model demonstrated a good predictive ability for the risk of delirium in AECOPD patients with respiratory failure （AUC=0.852, 95%CI:0.797～0.897）. Hosmer-Lemeshow goodness-of-fit test indicated high model accuracy （χ² = 2.309, P = 0.970）. Decision curve analysis （DCA） demonstrated that at high-risk thresholds of 0.0-0.4, the combined predictive value of mechanical ventilation duration, serum BDNF, ALB, CRP, and miR-212-5p levels for delirium risk in AECOPD patients with respiratory failure showed superior net benefit compared to individual indicators. Conclusion Prolonged mechanical ventilation duration, decreased serum BDNF, ALB and miR-212-5p levels, and the elevated serum CRP leves are all influencing factors for the occurrence of delirium in patients with AECOPD with respiratory failure. Clinically, these factors can serve as auxiliary tools for assessing delirium occurrence. these factors can be utilized to assist in the assessment of the occurrence of delirium.
- Chronic obstructive pulmonary disease,
- Acute exacerbation,
- Respiratory failure,
- Delirium,
- Influencing factors,
- Nomogram

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