慢性阻塞性肺疾病急性加重期患者住院期间死亡的危险因素研究

Risk Factors of Death in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease during Hospitalization

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者住院期间死亡的危险因素。方法回顾性选取2020年1月至2023年3月青海省心脑血管病专科医院收治的AECOPD患者200例为研究对象,收集患者的临床资料,根据住院期间预后情况将患者分为存活组184例和死亡组16例。采用ROC曲线分析动脉血二氧化碳分压(PaCO_(2))、胱抑素C(CysC)、降钙素原(PCT)、心肌肌钙蛋白I(cTnI)、脑钠肽(BNP)预测AECOPD患者住院期间死亡的最佳截断值;采用多因素Logistic回归分析探讨AECOPD患者住院期间死亡的危险因素。结果死亡组慢性阻塞性肺疾病(COPD)急性加重次数≥3次者占比、合并心力衰竭者占比、合并低蛋白血症者占比、PaCO_(2)、CysC、PCT、cTnI、BNP高于存活组(P<0.05)。ROC曲线分析结果显示,PaCO_(2)、CysC、PCT、cTnI、BNP预测AECOPD患者住院期间死亡的曲线下面积分别为0.840、0.730、0.808、0.860、0.735,最佳截断值分别为40.1 mm Hg、1.66 mg/L、1.54μg/L、0.047 ng/L、320 ng/L。多因素Logistic回归分析结果显示,COPD急性加重次数≥3次〔OR=2.105,95%CI(1.115,3.979)〕、合并心力衰竭〔OR=1.582,95%CI(1.167,2.145)〕、合并低蛋白血症〔OR=2.083,95%CI(1.159,3.743)〕、PaCO_(2)≥40.1 mm Hg〔OR=3.115,95%CI(1.194,8.126)〕、CysC≥1.66 mg/L〔OR=1.945,95%CI(1.129,3.350)〕、PCT≥1.54μg/L〔OR=3.975,95%CI(1.578,10.013)〕、cTnI≥0.047 ng/L〔OR=4.492,95%CI(1.771,11.393)〕、BNP≥320 ng/L〔OR=1.683,95%CI(1.215,2.331)〕是AECOPD患者住院期间死亡的危险因素(P<0.05)。结论COPD急性加重次数≥3次、合并心力衰竭、合并低蛋白血症、PaCO_(2)≥40.1 mm Hg、CysC>1.66 mg/L、PCT≥1.54μg/L、cTnI≥0.047 ng/L、BNP≥320 ng/L是AECOPD患者住院期间死亡的危险因素。

Objective To explore the risk factors of death in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)during hospitalization.Methods A total of 200 patients with AECOPD admitted to Qinghai Provincial Cardiovascular and Cerebrovascular Disease Specialist Hospital from January 2020 to March 2023 were restrospectively selected as the research subjects.Clinical data of patients were collected,the patients were divided into survival group(n=184)and death group(n=16)according to the prognosis during hospitalization.ROC curve was used to analyze the best cut-off values of partial pressure of carbon dioxide(PaCO_(2)),cystatin C(CysC),procalcitonin(PCT),cardiac tropnin I(cTnI),brain natriuretic peptide(BNP)in predicting death in patients with AECOPD during hospitalization.Multivariate Logistic regression analysis was used to analyze the risk factors of the death in patients with AECOPD during hospitalization.Results The proportion of patients with the number of acute exacerbations of chronic obstructive pulmonary disease(COPD)≥3,the proportion of patients with heart failure,the proportion of patients with hypoalbuminemia,PaCO_(2),CysC,PCT,cTnI,BNP in the death group were higher than those in the survival group(P<0.05).The results of ROC curve analysis showed that the AUC of PaCO_(2),CysC,PCT,cTnI and BNP in predicting death in patients with AECOPD during hospitalization were 0.840,0.730,0.808,0.860 and 0.735,respectively.The best cut-off values were 40.1 mm Hg,1.66 mg/L,1.54μg/L,0.047 ng/L and 320 ng/L,respectively.Multivariate Logistic regression analysis showed that the number of acute exacerbations of COPD≥3[OR=2.105,95%CI(1.115,3.979)],heart failure[OR=1.582,95%CI(1.167,2.145)],albuminemia[OR=2.083,95%CI(1.159,3.743)],PaCO_(2)≥40.1 mm Hg[OR=3.115,95%CI(1.194,8.126)],CysC≥1.66 mg/L[OR=1.945,95%CI(1.129,3.350)],PCT≥1.54μg/L[OR=3.975,95%CI(1.578,10.013)],cTnI≥0.047 ng/L[OR=4.492,95%CI(1.771,11.393)],BNP≥320 ng/L[OR=1.683,95%CI(1.215,2.331)]were the risk factors of death in patients with AECOPD during hospitalization(P<0.05).Conclusion The number of acute exacerbations of COPD≥3,heart failure,albuminemia,PaCO_(2)≥40.1 mm Hg,CysC≥1.66 mg/L,PCT≥1.54μg/L,cTnI≥0.047 ng/L,BNP≥320 ng/L are the risk factors of death in patients with AECOPD during hospitalization.