DECAF评分联合红细胞分布宽度预测慢性阻塞性肺疾病急性加重期短期预后

Short-term prognosis of acute exacerbation of chronic obstructive pulmonary disease predicted by DECAF score combined with red blood cell distribution width

目的:探究DECAF评分联合红细胞分布宽度(RDW)预测慢性阻塞性肺疾病急性加重期(AECOPD)患者短期死亡的临床价值。方法:回顾性纳入2014年6月至2021年6月在宜兴市人民医院住院治疗的462例AECOPD患者,根据28 d生存情况分为死亡组60例和生存组402例。收集入院时两组患者的临床资料,采用多因素Logistic回归分析AECOPD患者28 d死亡的危险因素,并采用ROC曲线对DECAF联合RDW诊断AECOPD患者28 d死亡的效能进行评定。结果:单因素分析显示,与生存组比较,死亡组年龄>70岁、合并呼吸衰竭、意识改变、机械通气治疗的比例以及入院时血小板、RDW、IL-6、C-反应蛋白(CRP)、DECAF评分升高(P<0.05)。多因素Logistic回归分析结果显示,入院时意识改变(OR=1.885,95%CI:1.160~3.063),RDW(OR=1.426,95%CI:1.073~1.900)、DECAF评分(OR=1.790,95%CI:1.181~2.712)升高,住院期间合并呼吸衰竭(OR=1.459,95%CI:1.051~2.026)是AECOPD患者28 d死亡的独立危险因素。ROC曲线分析表明,DECAF评分联合RDW诊断AECOPD患者28 d死亡的AUC为0.899(95%CI:0.857~0.932)。结论:DECAF评分、RDW升高是AECOPD患者28 d死亡的独立危险因素,二者联合应用可提高预测AECOPD患者死亡的效能。

Objective:To explore the clinical value of DECAF score combined with red blood cell distribution width(RDW)in predicting short-term death in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:A total of 462 AECOPD patients hospitalized in Yixing People’s Hospital from June 2014 to June 2021 were retrospectively divided into death group(n=60)and survival group(n=402)according to their 28-day survival.The clinical data of the two groups at admission were collected.The risk factors of 28-day death in patients with AECOPD were analyzed by multivariate Logistic regression,and the efficacy of DECAF combined with RDW in the diagnosis of 28-day death in patients with AECOPD was evaluated by ROC curve.Results:Univariate analysis showed that compared with the survival group,the death group was older than 70 years old,complicated with respiratory failure,consciousnesschanges,the proportion of mechanical ventilation treatment,and the scores of platelet,RDW,IL-6,CRP and DECAF on admission were significantly increased(P<0.05).The results of multivariate Logistic regression analysis showed that the consciousness changesat admission(OR=1.885,95%CI:1.160-3.063),RDW(OR=1.426,95%CI:1.073-1.900),DECAF score(OR=1.790,95%CI:1.181-2.712)and respiratory failure during hospitalization(OR=1.459,95%CI:1.051-2.026)were independent risk factors for 28-day death in AECOPD patients.ROC curve analysis showed that the AUC of 28-day death in patients with AECOPD diagnosed by DECAF score combined with RDW was 0.899(95%CI:0.857-0.932).Conclusion:The increase of DECAF score and RDW are independent risk factors of 28-day death in AECOPD patients,and the combined application of the two can improve the performance of predicting the death of AECOPD patients.