Clinical Value Of Serum Markers In Predicting Hospitalization And Prognosis Of AECOPD Patients

Objective: The levels of serum levels of interleukin 6(IL-6),copeptin,middle segment peptide of adrenal medulla(MR-proADM),and 8 isoprostanes(8-iso-PG)in the serum of patients with chronic obstructive pulmonary disease(COPD)(including phase A1,A2)and remission phase(including P1,P2 phase)were detected,and they were evaluated in the hospital stay of the patients with AECOPD.The clinical value of inter and short and medium-term prognosis.Methods: From January 2016 to September 2016,106 patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)hospitalized in two families of Shaanxi People’s Hospital were collected,and the levels of IL-6,copeptin,MR-proADM and 8-iso-PG were detected in the acute exacerbation period and remission stage respectively,and the clinical indexes and patients’ short and medium-term diseases were analyzed.The correlation of the outcome of the disease.Results:1.The difference between the clinical biochemical indexes of different pulmonary function during the hospitalization was compared: there were statistical differences between the A1 group,the A2 group,the P1 group,the P2 group and the PO2,PCO2 and WBC(P<0.05)during the hospitalization.There were no statistical differences between the four groups.2.The differences of biological indexes among different pulmonary functions during hospitalization were compared: there were significant differences in IL-6,copeptin,MR-proADM and 8-iso-PG between A1 group,A2 group,P1 group and P2 group during hospitalization(P<0.05).3.Correlation analysis between clinical indicators and biomarkers: smoking index(P=0.001),white blood cell count(P=0.002)and IL-6 have positive correlation,andFEV1%pred(P=0.010)and IL-6 have negative correlation.White blood cell count (P =0.001) and hospital stay (P=0.003) were positively correlated with copeptin.FEV1%pred(P=0.034)was negatively correlated with copeptin.PCO2(P=0.002)is positively correlated with MR-proADM.PO2(P=0.006)and FEV1%pred(P=0.008)have negative correlation with MR-proADM.Smoking index(P=0.029),PCO2(P=0.018),white blood cell count(P=0.008)have positive correlation with 8-iso-PG,and PO2(P=0.026),FEV1%pred(P=0.028)and 8-iso-PG have negative correlation.4.Multivariate stepwise regression analysis of the factors affecting the short-term prognosis of AECOPD patients: by using multivariate linear stepwise regression analysis,using the deteriorating group as the dependent variable(Y),age,the duration of COPD,the smoking index,the time of hospitalization,the IL-6,copeptin,MR-proADM and8-iso-PG as the self variable(X1-X8),this study set the test water for the independent variable.It is assumed to be alpha into =0.05 and alpha to =0.10,and the independent variable to enter the regression equation is copeptin(X6).5.Multivariate stepwise regression analysis was carried out on the effects of AECOPD patients’ medium-term prognosis: multivariate linear stepwise regression analysis was used,with the deteriorating group as the dependent variable(Y),age,the duration of COPD,the smoking index,the time of hospitalization,the IL-6,copeptin,MR-proADM and 8-iso-PG as independent variables(X1-X8).The test level of the set of independent variables was alpha into =0..05,alpha out of =0.10.Finally,the independent variables that enter the regression equation are IL-6(X5)and MR-proADM(X7).6.Copeptin’s ROC curve for the short-term prognosis of AECOPD patients: the area under the curve of copeptin(AUC)is 0.779,the sensitivity is 74.1%,the specificity is74.0%,and the best critical point is 0.014 pmol / L.7.The ROC curve of IL-6 and MR-proADM for the medium-term prognosis of AECOPD patients: the AUC values of these two were 0.815 and 0.817,respectively,and the sensitivity was 81.2%,84.1%,and the specificity was 65.6% and 84.4%,respectively.The best critical point were 18.591 ng / L and 0.853 nmol / 1.Compared tothe two,the AUC value was basically equal,but the predictive sensitivity and specificity of the serum MR-proADM level were higher than that of IL-6,and the combined two markers did not improve the predictive value of the medium-termprognosis.Conclusion:1.Copeptin is related to the duration of hospitalization,the degree of inflammation and the severity of pulmonary function during hospitalization,and can predict the outcome of the patients within 6 months after discharge.It is an ideal biomarker for the short-term prognosis assessment of AECOPD patients.2.IL-6 was associated with the smoking index,the degree of inflammatory response and the severity of lung function during hospitalization,and MR-proADM was associated with blood gas analysis and the severity of lung function during hospitalization.Although IL-6 can predict the patient’s prognosis within 18 months after discharge,its sensitivity and specificity are lower than that of MR-proADM,and the combined detection of the two does not improve the predictive value of the medium-term prognosis.Therefore,a separate detection of MR-proADM can be used as an ideal biomarker for the evaluation of the medium-term prognosis of AECOPD patients.3.8-iso-PG is associated with the smoking index,the degree of inflammatory response,blood gas analysis,and the severity of the lung function during hospitalization.It can be used as a biomarker for the assessment of the period of hospitalization,but there is no sufficient evidence to support it as a biomarker for assessing the outcome of short and medium-term disease in AECOPD patients.