Risk Factors Analysis Of Left Heart Failure In Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Background:Chronic obstructive pulmonary disease（COPD）and heart failure（HF）are common diseases in middle and elderly aged patients.Share common risk factors and pathophysiological mechanisms are important causes of morbidity and mortality in people.The both often coexist and interact with each other and have a poor prognosis.Acute exacerbation of chronic obstructive pulmonary disease（AECOPD）and left heart failure（LHF）have similar clinical manifestations and different treatment principles.Therefore,timely and correct diagnosis and differential diagnosis in order to take targeted treatments are essential to reduce the risk of death.Objective:To investigate the related risk factors associated with left heart failure in patients with acute exacerbation of chronic obstructive pulmonary disease,and to establish a predictive regression model to provide reference for clinical diagnosis and treatment.Methods:A total of 187 patients with AECOPD were enrolled in the Minda Hospital of Hubei MinZu University from July 01,2016 to June 30,2018.According to LVEF,NT-proBNP and related symptoms,divided into non-LHF and LHF group.Collect general information of cases,number of acute exacerbations,time of chronic obstructive pulmonary disease,body mass index,smoking index,laboratory and imaging data,perform statistical analysis,and screen statistically significant differences.Unconditional logistic regression analysis was used to determine risk factors.The prediction model was established based on the results of Logistic regression analysis,and the prediction value of the regression model was tested by ROC curve.Results:LHF and non-LHF group in the time of COPD,low albumin（Lalb）incidence,incidenceofrespiratoryfailure,incidenceofhypercapnia（Hco₂）,pulse,respiratory,GOLD rating,number of acute exacerbations inrecent year（NOAE）,C-Reactive protein,procalcitonin,plasma prothrombin time,plasma thrombin time,D-dimer,albumin,,PaO2,PaCO2,SaO2,blood lactic acid（Lac）,FEV₁,FEV₁%pred,left ventricular diameter shortening rate（LVFS）,pulmonary artery diameter,pulmonaryarterypressure,andrightventricularend-diastolic diameter（RVEDD）were statistically significant（P<0.05）.Logistic regression analysis showed that Lalb（P=0.021,OR=0.173）and LVFS（P=0.005,OR=0.746）were protective factors for AECOPD combined with LHF,NOAE（P=0.005,OR=2.936）,Hco₂（P=0.000,OR=8.118）,Lac（P=0.006,OR=2.924）,RVEDD（P=0.001,OR=1.336）were the independent risk factor for AECOPD combined with LHF.According to the results of logistic regression analysis,the AECOPDcombinedleftheartfailurepredictionmodelwas established:LogitP=0.580+1.077NOAE（per-year）-1.754Lalb（no=0,yes=1）+2.094Hco₂（no=0,yes=1）+1.073Lac（mmol/L）+0.290RVEDD（mm）-0.293LVFS（%）,the model predicts a total coincidence rate of 88.2%,and the ROC curve results in LogitP with an AUC of 0.893.The AUC for diagnosis of AECOPD combined with LHF occurred were 0.731,0.731,0.659,0.689 of NOAE,Hco₂,Lac,RVEDD respectively,P<0.05.Conclusion:（1）The incidence of AECOPD combined with LHF is higher,about19.8%,mainly patients with severe and very severe airflow limitation,accounting for78.3%;（2）correction of albuminemia,increased left ventricular diameter shortening rate,the risk of AECOPD combined with LHF occur decreased;（3）The increase in NOAE,Hco₂,Lac,and RVEDD indicate that an increased risk of AECOPD combined with LHF;（4）The regression prediction model LogitP has higher prediction value and can be applied in clinical practice.