| Objective:Red blood cell distribution width（RDW）and serum uric acid（SUA）can predict the clinical prognosis of various diseases.However,the combined predictive value of RDW and SUA for the prognosis of acute exacerbation of chronic obstructive pulmonary disease（AECOPD）has not been reported so far.The purpose of this study was to investigate the relationship between hospital mortality in patients with RDW,SUA,and AECOPD,and to analyze the value of these indicators in evaluating the prognosis of patients with AECOPD.Methods:Patients with AECOPD diagnosed according to the Chinese Expert Consensus on the Diagnosis and Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease（2014 Revision）were selected from the Emergency Department of Internal Medicine,Respiratory Department and Critical Medicine Department of Luan Hospital Affiliated to Anhui Medical University from January 2016to February 2018.Patients with chronic renal failure,gout,dry and severe liver and kidney insufficiency,blood diseases,respiratory diseases,cancer diseases and any drugs that may affect the levels of RDW and SUA were excluded.A total of 105 AECOPD patients were enrolled in the study.The CBC parameters,age,sex and other general clinical data and vital signs of all AECOPD patients on admission day were recorded,and 4 mL blood from median elbow vein was extracted on admission day with informed consent of the patients,and sent to the laboratory of our hospital,using automatic dry chemical analyzer and automatic blood cell analyzer and other instruments and equipment.The samples were analyzed,including hemoglobin（Hb）,mean corpuscular volume（MCV）,white blood cell count（WBC）,creatinine（Cr）,and C-reactive protein（CRP）.The indexes of RDW（%）and SUA（umoL/L）were measured on the first day,the third day,the fifth day and the seventh day of admission of AECOPD patients.According to whether AECOPD patients died in hospital during hospitalization（8-21days）,they were divided into in-hospital death group（64 cases）and survival discharge group（41 cases）.SPSS21.0 software was used to analyze the parameters of the two groups of patients.The utilization rate of the counting data（%）was expressed and compared with the Maple 2 test.The measurement data were expressed as（±s）and compared by t-test.RDW and SUA indexes were analyzed by ROC curve and the best truncation value was obtained.Multivariate logistic regression analysis was used to determine the independent risk factors of in-hospital mortality in AECOPD patients.The difference was statistically significant with P<0.05.Results:The age and Hb level of the patients in the hospital were higher than those in the surviving group,and the difference was statistically significant（P<0.05）.The RDW（D3）,RDW（D5）,and RDW（D7）levels in the in-hospital death group were higher than those in the surviving group,and the difference was statistically significant（P<0.05）.The SUA（D1）,SUA（D3）,SUA（D5）,and SUA（D7）levels in the in-hospital death group were higher than those in the surviving group,and the difference was statistically significant（P<0.05）.RDW（D3）（AUC:0.784,95%CI:0.694-0.859,optimal cutoff:>13.8）,RDW（D5）（AUC:0.938,95%CI:0.874-0.976,optimal cutoff:>13.6）,RDW（D7）（AUC:0.990,95%CI:0.946-1.000,optimal cut-off value:>13.5）can better predict the occurrence of in-hospital death in patients with AECOPD.SUA（D3）（AUC:0.661,95%CI:0.562-0.751,optimal cutoff value:>328.7）,SUA（D5）(AUC:0.790,95%CI:0.700-0.864,optimal cutoff value:>323.7 SUA（D7）（AUC:0.860,95%CI:0.777-0.921,optimal cutoff:>327.0）had a good predictive of in-hospital death in patients with AECOPD.As the admission time prolonged,the AUC value became larger and larger（RDW:0.501<0.784<0.938<0.990,SUA:0.580<0.661<0.790<0.860）.Age（HR:1.068,95CI%:1.017-1.123）,RDW（D7）（HR:10.698,95CI%:2.873-39.813）,SUA（D7）（HR:1.016,95CI%:1.006-1.027）are all AECOPD An independent risk factor for in-hospital death in patients.Conclusion:Elevated levels of RDW and SUA are an independent risk factor for hospital mortality in AECOPD patients.Continuous detection of SUA and RDW during treatment has important clinical value in judging prognosis,especially elevated levels of SUA（D7）and RDW（D7）may indicate poor prognosis.Because the detection of RDW and SUA levels in AECOPD patients is an economical and convenient way,the potential predictive value of RDW and SUA changes in the prognosis of AECOPD patients should be integrated into the overall management of ACOPD patients,but further research is needed to clarify Potential mechanism. |
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