基于N端脑利钠肽前体、D-二聚体及降钙素原和临床病例资料构建AECOPD预后模型

Combining the Expression Levels of N-Terminal Pro-Brain Natriuretic Peptide,D-Dimer and Procalcitonin to Construct a Prognosis Model for Patients with Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的:探究重症慢性阻塞性肺疾病急性加重期(AECOPD)患者血清中N端脑利钠肽前体(NT-proBNP)、D-二聚体(D-D)、降钙素原(PCT)的水平以及三者联合评估患者出院1年内预后的预测价值。方法:回顾性分析2018年1月—2022年10月于我院接受住院治疗的AECOPD患者124例的临床资料,患者分为存活组(99例)和死亡组(25例)。多因素Logistic回归模型分析患者出院1年内死亡的独立危险因素。受试者工作特征(ROC)曲线分析三者联合检测评估患者出院1年内预后的预测价值。结果:多因素Logistic回归分析显示,上1年急性加重≥2次、改良版英国医学研究委员会呼吸问卷(mMRC)>2级、铜绿假单胞菌、无长期家庭氧疗(LTOT)、NT-proBNP>1.1g/L、D-D>2.4 mg/L、PCT>0.09g/L以及右心室增大,均为AECOPD患者出院后1年内死亡的独立危险因素(P<0.05)。三者联合预测时曲线下面积(AUC)为0.830(95%CI:0.801~0.859,P<0.001),灵敏度为95.15%,特异度为74.28%,表明联合预测价值较高。风险评分模型将患者分为低(≤77分)、中(>77分且≤89分)、高风险(>89分)3组人群。模型评价提示风险评分模型准确度高。结论:上1年急性加重≥2次、mMRC>2级、铜绿假单胞菌、无LTOT、NT-proBNP>1.1 g/L、D-D>2.4mg/L、PCT>0.09g/L以及右心室增大,均为AECOPD患者出院后1年内死亡的独立危险因素。NT-proBNP、D-D及PCT三者联合检测AECOPD患者出院后1年内预后情况具有的较高预测价值,为临床评估病情和判定预后提供参考。

Objective:To explore the serum levels of N-terminal pro-brain natriuretic peptide(NT-proBNP),D-dimer(D-D)and procalcitonin(PCT)in patients with acute exacerbation of severe chronic obstructive pulmonary disease(AECOPD)and the predictive value of their combination in evaluating the prognosis of patients within one year after discharge.Methods:The clinical data of 124 AECOPD patients hospitalized in our hospital from January 2018 to October 2022 were retrospectively analyzed.The patients were divided into survival group(99 cases)and death group(25 cases).Multivariate Logistic regression model was used to analyze the independent risk factors of death within one year after discharge.Analysis of ROC curve,the predictive value of the combined detection of ROC and in evaluating the prognosis of patients within one year after discharge.Results:Multivariate Logistic regression analysis showed that the acute exacerbation≥2 times in the last year,the modified British Medical Research Council Respiratory Questionnaire(mMRC)>grade 2,Pseudomonas aeruginosa,LTOT,NT-proBNP>1.1g/L,D-D>2.4mg/L,PCT>0.09g/L,and the right ventricle was enlarged.The area under the curve(AUC)is 0.830(95%CI:0.801~0.859,P<0.001),the sensitivity is 95.15%,and the specificity is 74.28%,indicating that the joint prediction is of high value.The risk scoring model divides patients into three groups:low(≤77 points),medium(>77 points and≤89 points)and high-risk(>89 points).The model evaluation indicates that the risk scoring model has high accuracy.Conclusion:Acute exacerbation≥2 times in the last year,mMRC>grade 2,Pseudomonas aeruginosa,LTOT-free,NT-proBNP>1.1g/L,D-D>2.4mg/L,PCT>0.09g/L and right ventricular enlargement are all independent risk factors for the death of AECOPD patients within one year after discharge.The combined detection of NT-proBNP,D-D and PCT has high predictive value for the prognosis of AECOPD patients within one year after discharge,which provides reference for clinical evaluation of the disease and judgment of prognosis.