AECOPD伴外周水肿患者预后及住院死亡的危险因素分析-现代医学

AECOPD伴外周水肿患者预后及住院死亡的危险因素分析

单位：成都市第三人民医院呼吸与危重症科, 四川成都 610031

分类号：R563

出版年·卷·期（页码）：2021·49·第八期（937-944）

摘要：

目的：探讨慢性阻塞性肺疾病急性加重（AECOPD）伴外周水肿患者预后情况及住院死亡的危险因素。方法：回顾性收集成都市第三人民医院住院AECOPD患者247例，比较伴和不伴外周水肿两组患者预后，对伴外周水肿患者采用多因素logistic回归分析探讨患者住院死亡的危险因素，进一步使用受试者工作特征（ROC）曲线确定危险因素的最佳截断值。结果：本研究发现伴外周水肿的AECOPD患者住院死亡率高达30%（49/163），为不伴外周水肿患者的17.6倍。多因素logistic回归分析显示侵袭性肺曲霉感染（IPA）（OR=13.258）、嗜中性粒细胞/淋巴细胞比率（NLR）升高（OR=1.053）、贫血（OR=10.279）、肌钙蛋白T （TnT）水平升高（OR=1.01）、无创机械通气（OR=9.717）、肺性脑病（OR=7.6）和多器官功能障碍综合征（MODS）（OR=15.598）是AECOPD伴外周水肿患者死亡的独立危险因素。ROC曲线显示NLR （≥8.24）+TnT （≥37.7 ng·L^-1）与血红蛋白（≤ 124.5g·L^-1）联合检测对预测此类患者住院死亡的效能最高，敏感度为81.6%，特异度为81.6%。结论：伴外周水肿是AECOPD患者预后不良的临床特征，若合并IPA、NLR升高、贫血、TnT升高、无创机械通气、肺性脑病、MODS危险因素，则患者住院死亡风险高。

Objective: To investigate the risk factors of hospitalized death in patients with AECOPD-related peripheral edema. Methods: 247 AECOPD patients in Chengdu Third People's Hospital were divided into groups with and without peripheral edema, and the prognosis of the two groups was compared. Logistic regression analysis modeling were performed to predict the risk factors for hospitalized death in patients with AECOPD-related peripheral edema. Next, receiver operating characteristics (ROC) curves were used to determine the optimal cut off value for continuous variables of the risk factors. Results: The study found that AECOPD patients with peripheral edema had a mortality rate of 30%(49/163) and was 17.6 times higher than patients without peripheral edema in hospital.Logistic regression analysis modeling revealed that invasive pulmonary aspergillosis(OR=13.258), elevated neutrophil lymphocyte ratio (OR=1.053), anemia (OR=10.279), elevated troponin T (OR=1.01),noninvasive ventilation (OR=9.717), pulmonary encephalopathy (OR=7.6), and multiple organ dysfunction(MODS) (OR=15.598) were independent risk factors for hospitalized death in AECOPD patients with peripheral edema. The ROC curve showed that the combination of neutrophil/lymphoid ratio (≥ 8.24), troponin T(≥ 37.7 ng·L^-1),and hemoglobin (≤ 124.5 g·L^-1) was the most effective in predicting inpatient death, with a sensitivity of 81.6% and a specificity of 81.6%. Conclusion: AECOPD with peripheral edema is a clinical feature of poor prognosis. The risk factors for in-hospital death in AECOPD patients with peripheral edema include invasive pulmonary aspergillus infection, increased neutrophil/lymphocyte ratio, anemia, elevated troponin T level, noninvasive mechanical ventilation, and pulmonary encephalopathy, and MODS.

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