| Objective:Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is an acute exacerbation of respiratory symptoms in patients with chronic obstructive pulmonary disease,which is characterized by exacerbation of dyspnea,cough,sputum volume and/or purulent sputum,exceeding the daily variation,and leading to the need to change drug treatment.The main cause of acute exacerbation of COPD is respiratory infection,which can lead to a sharp decline in lung function,worsen the prognosis of the disease and increase the mortality of the patients.To provide guidance for clinical work,we analyze the clinical differences between acute exacerbation of chronic obstructive pulmonary disease(AECOPD)patients with and without CAP.Method:From January 1,2017 to December 31,2017,we retrospectively collected the AECOPD patients hospitalized in respiratory department of Taicang Hospital Affiliated to Soochow University.The patients were divided into CAP-AECOPD group and nonCAP-AECOPD group according to whether they combined with imaging changes of CAP at admission.Then,in each group,the patients over or equal 65 years old were defined as the old-age subgroup,and the ones under to 65 years old were defined as the young-age subgroup according to CURB-65.Through the analysis and comparison between the two groups,the differences of clinical characteristics,laboratory examination and clinical outcome between the two groups were studied,the risk of reoccurrence of acute exacerbation within one year was evaluated,and a good index system for predicting AECOPD combined with cap was established.Results:In total,182 AECOPD patients were included in this study,142 males and 40 females.78 in CAP-AECOPD group and 104 in nonCAP-AECOPD group.78%of the patients had basic diseases,the most common diseases were hypertension(39.6%),cerebrovascular accident(15.9%)and prostatic hyperplasia(13.7%).(1)Clinical featuresIn clinical symptoms,the incidence of fever(48.72%vs 18.27%,P=0.000)and purulent sputum(purulent sputum:98.72%vs 88.46%,P=0.008)of CAP-AECOPD group was significantly higher than nonCAP-AECOPD group,but there was no significant difference in pulmonary rales between the two groups nor age subgroups(P>0.05).(2)Laboratory examinationWhite blood cell count(WBC)(11.26±4.58 ×109/L vs 7.08±2.47 ×109/L,P=0.000)and neutrophil percentage(80.88±8.65%vs 73.95±9.18%,P=0.000)of CAP-AECOPD group were significantly higher than nonCAP-AECOPD group.There was no significant difference in age subgroups.The eosinophil count(EOS)of CAP-AECOPD group was lower than nonCAP-AECOPD group(0.96±2.47%vs 1.65±2.10%,P<0.05).In nonCAP-AECOPD group,EOS of the young-age subgroup was higher than that of the old-age subgroup(2.82±2.38 ×109/L vs 1.50±2.03 ×109/L,P<0.05),while there was no significant difference between age subgroups in CAP-AECOPD patients.In young-age patients,the EOS of CAP-AECOPD patients was lower than that of nonCAP-AECOPD patients(0.88±1.12 ±109/L vs 2.82±2.38 ×109/L,P<0.05),but there was no significant difference in old-age patients.CRP(114.14±102.25 mg/L vs 18.30±26.68 mg/L,P=0.000)and D-dimer(1603.21±3515.80 μg/L vs 687.88±697.22 μg/L,P<0.05)in CAP-AECOPD group was higher than that in nonCAP-AECOPD group.There was no significant difference in CRP between age subgroups in CAP-AECOPD patients and nonCAP-AECOPD patients.CRP of CAP-AECOPD patients was higher than that of nonCAP-AECOPD patients in young-age patients(P<0.05),and the same was true in the old-age group.The analysis of age subgroups in the nonCAP-AECOPD patients showed that the D-dimer in the young-age subgroup was significantly lower than that in the old-age subgroup(328.04±294.14 μg/L vs 742.10±718.93 μg/L,P<0.01),but there was no difference between age subgroups in CAP-AECOPD patients.The oxygenation index(OI)of CAP-AECOPD patients was lower than that of nonCAP-AECOPD patients(246.18±58.54 mmHg vs 275.09±59.27 mmHg,P<0.01),but there was no significant difference in pH and PaCO2 between the two groups(P>0.05).There was no difference between age subgroups in CAP-AECOPD patients and nonCAP-AECOPD patients.In old-age patients,the OI of the CAP-AECOPD group was lower than that of the nonCAP-AECOPD group(244.82±58.13 mmHg vs 274.45±59.52 mmHg,P<0.01),and there was no difference in young-age patients.(3)Clinical outcomeCAP-AECOPD patients have lower three-day improvement rate(60.03%vs 75.0%,P<0.05),higher treatment failure rate(15.38%vs 5.76%,P<0.05),longer hospital stay(11.88±4.59 days vs 9.77±3.33 days,P<0.01)and more expensive treatment cost(13923.79±8726.55 yuan vs 10362.31±5250.79 yuan,P<0.01),especially for the elderly ones.However,there was no significant difference in the risk of acute exacerbation within one year between CAP-AECOPD and nonCAP-AECOPD patients(OR=0.903,95%CI:0.484-1.687).(4)ROC analysis for predicting the probability of AECOPD concurrent CAPROC curve analysis showed that the cutoff value of CRP was 24,25mg/L,the sensitivity was 81.6%,and the specificity was 78.6%.The cutoff value of D-dimer was 595.2μg/L,the sensitivity was 86.4%,and the specificity was 63.1%.The area under the curve(AUC)of CRP combined with D-dimer is the largest compared with CRP and D-dimer(AUC=0.882,95%CI:0.829-0.936),which showed that CRP combined with D-dimer can better predict the occurrence of CAP in AECOPD patients than CRP and D-dimer.When the prediction probability of CRP combined with D-dimer was 0.3775488,the sensitivity was 80.5%,and the specificity was 88.3%.Conclusions:CAP-AECOPD patients had more severe bacterial infection symptoms,inflammation index and degree of hypoxia than nonCAP-AECOPD patients.CAP-AECOPD patients had lower three-day improvement rate,higher treatment failure rate,longer hospitalization time and more hospitalization expenses,but it did not increase the risk of acute exacerbation in AECOPD patients within one year.In old-age CAP-AECOPD patients,the clinical symptoms were more obvious,the level of D-dimer was higher,the degree of hypoxia was more serious,and the clinical outcome was worse.CRP combined with D-dimer can better predict the probability of AECOPD patients concurrent CAP. |
PDF Full Text Request