Clinical Features And Risk Factors Of Acute Exacerbation Of COPD Complicated With Deep Venous Thrombosis Of Lower Extremity

Objective:To explore the clinical characteristics and risk factors of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with deep vein thrombosis(DVT).Methods:Clinical data of patients diagnosed with AECOPD in the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Kunming Medical University from January 2018 to October 2020 were retrospectively analyzed.Patients with combined DVT were divided into AECOPD combined with DVT group,and patients without combined DVT were divided into AECOPD group.SPSS25.0 statistical software was used to analyze the differences between the clinical data of two groups of patients,and binary Logistic regression model was used to analyze the risk factors of AECOPD patients with DVT,and ROC curve was used to test the predictive value of the regression model.Results1.Univariate analysis1.1 General information There were statistically significant differences in gender,age and course of disease between the two groups(P<0.05).There was no significant difference in BMI(P>0.05).1.2 History,clinical manifestations and prognosis Compared with the two groups,there were significant differences in the proportion of complicated pulmonary heart disease,symmetrical edema of lower limbs,and length of hospital stay(P<0.05).There was no significant difference in hypertension,diabetes mellitus,smoking,smoking index,drinking,cough,sputum,fever,wheezing,lower limb pain and asymmetric edema(P>0.05).1.3 Laboratory examination Compared with the two groups,there were statistically significant differences in oxygenation index,respiratory failure,neutrophil percentage,FDP,D-dimer,CRP,NT-proBNP(P<0.05).But in pH,PaO2,PaCO2,white blood cell,red blood cell,hemoglobin,hematocrit,platelet,thrombocyte,total protein,albumin,globulin,white bulb ratio,total cholesterol,free cholesterol,triglyceride,high density lipoprotein,low density lipoprotein,FIB,APTT,PT had no statistical significance(P>0.05).1.4 Pulmonary function Compared with the two groups,there was a statistically significant difference in FEV1/FVC values(P<0.05),while there was no statistically significant difference in FEVi%pred and GOLD grades(P>0.05).2 Binary Logistic regression analysisAfter excluding confounding factors,the results showed that age,course of disease,symmetrical edema of lower limbs,D-dimer and APTT level were independent risk factors for AECOPD with DVT(P<0.05).3 ROC curve analysisAUC of D-dimer was 0.840(95%CI=0.773-0.907,P<0.001),CUT off value was 0.515mg/L,sensitivity was 86.7%,specificity was 67%.The AUC of APTT was 58.6%(95%CI=0.491-0.681,P<0.05),the CUT off value was 38.75S,the sensitivity was 76.7%,and the specificity was 46.7%.The AUC of D-dimer combined with APTT for ROC curve analysis was 0.889(95CI%:0.840-0.938,P<0.001),the sensitivity was 76.8%,and the specificity was 88.3%.Conclusion1.AECOPD patients with DVT lack specific clinical features,AECOPD patients should be alert to the occurrence of DVT when bilateral lower extremity edema occurs;2.Advanced age,long course of disease,symmetrical edema of both lower limbs,increased D-dimer and decreased APTT were independent risk factors for AECOPD patients with DVT;Women,patients with pulmonary heart disease,hypoxemia,and inflammation may increase the risk of AECOPD patients with DVT.3.D-dimer combined with APTT detection can improve the diagnostic rate and specificity of DVT in AECOPD patients.