Platelet Parameters To Evaluate The Clinical Possibility Of Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease Complicated With Pulmonary Embolism

Objective:Platelets,as a kind of blood cells that can respond to the body’s inflammation and coagulation status,have received much attention in recent years.The purpose of this article is to investigate platelet-related parameters to evaluate whether patients with AECOPD have PE.We hope to use platelet-related parameters as a simple and inexpensive diagnostic tool to help evaluate the possibility and prognosis of patients with AECOPD and PE.Methods:A retrospective analysis of patients with AECOPD and patients with AECOPD and PE who had been diagnosed and diagnosed with CTPA in the Affiliated Hospital of Qingdao University from January 2010 to June 2019.Case-control analysis was performed on the related parameters of gender,age,previous medical history,heart rate,blood routine,C reactive protein（CRP）,D dimer,and blood gas analysis in the two groups of patients,with statistical differences.Factors were included in multi-factor Logistic regression analysis to define platelet parameters for diagnosis and prognosis of patients with AECOPD combined with PE,and draw ROC curves to evaluate the predictive value of each parameter to draw conclusions.Results:A total of 470 patients with AECOPD alone and 232 patients with AECOPD combined with PE were included in this study.Through statistical analysis,it was found that patients with AECOPD alone and patients with AECOPD and PE had no significant differences in gender,age,and smoking history.In the history of previous diseases,patients with AECOPD and PE combined with deep vein thrombosis（DVT）（OR=19.360）Compared with the AECOPD group alone,there were significantly more and statistically significant differences（P<0.05）.The clinical indicators of AECOPD combined with PE patients were D-dimer（OR=1.000）,CRP（OR=1.325）,and platelet distribution width level(Platelet Distribution width（PDW）（OR=3.173）,Mean platelet volume（MPV）（OR=0.042）,Monocyte to large platelet ratio（MLPR）（OR=68.678）were all higher than The AECOPD group was statistically significant（P<0.05）,large platelet counts（OR=0.909）in patients with AECOPD combined with PE were lower than those with AECOPD alone and had statistical differences（P<0.05）.The age,heart rate,white blood cell count,monocyte count,lymphocyte count,PCT,and platelet-lymphocyte ratio（PLR）of the two groups of patients Large platelet-lymphocyte ratio,pH,PaO₂,SaO₂,PaCO₂,HCO₃^-,and BE showed no significant difference（P>0.05）.The ROC curve was drawn for the above statistically significant indicators,and the AUC of MLPR was 0.855（95%CI 0.827-0.883）,indicating that when MLPR increased,the clinical possibility of AECOPD combined with PE was high,and when the value of MLPR was>At 1.04%,it has the best predictive value for AECOPD combined with PE.At this time,the sensitivity is 94.8%and the specificity is75.7%;while the large platelet count is reduced,the D-dimer,CRP is increased,and the AUC combined with DVT is 0.7～0.8,indicating that the clinical possibility of PE when AECOPD combined with the above factors is moderate;the AUC of PDW and MPV elevation is 0.6 to 0.7,and the clinical possibility of combining PE with the above factors is low.Conclusion:1.Increased PDW,MPV,MLPR and decreased large platelet count are independent risk factors for PE in patients with AECOPD.AUC of MLPR>0.8,and when MLPR>1.04%,it has high sensitivity and specificity（both>70%）,or it can be used as a reliable,simple,inexpensive,and can be used to evaluate the high possibility of AECOPD combined with PE Extensive use of laboratory indicators.PDW,MPV,large platelet count,the sensitivity is fair,the specificity is low,and the evaluation value is worse than MLPR.2.Elevated D dimer,CRP and combined DVT are also independent risk factors for PE in patients with AECOPD,and AUC are all between 0.7 and 0.8,indicating that the clinical possibility of AECOPD combined with PE is moderate when the above abnormalities occur.