Analysis Of Factors Related To The Death Within One Year After Discharge Of The Inpatients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Objectives:This study was conducted to analyse the independent factors associated with the death within 1 year after discharge for the inpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease(AECOPD).Built a regression model to predict the risk of death within 1 year after discharge for the inpatients with AECOPD.And provided a clinical basis for screening out patients with end-stage COPD and giving them more individualized palliative treatment or hospice care.Method:The clinical data of patients who admitted with AECOPD as the first diagnosis in period from January 1st,2019 to January 31 st,2020 was collected.The information including the basis situation,disease assessment,complication,laboratory examination result,phlegm pathogeny,color doppler echocardiography,therapeutic regimen.A prospective study was conducted by following up the patients included in the study by telephone for 1 year.Death from all causes was the terminal point of the follow-up.According to the survival outcome of the follow-up,we obtained the mortality within 1year after discharge of the patients with different clinical data and compared the difference of mortality between patients in different groups by univariate analysis.Applied the multifactorial binary logistic regression to analyse the independent risk factors affecting mortality within 1 year after discharge of AECOPD inpatients and built a regression model.Then we used the Receiver Operation Characteristic(ROC)Curve to evaluate the predictive capacity of the model for death-risk within one year after discharge of AECOPD inpatients.Results: This study included 205 patients.After follow-up,37 patients(18%)died within 1 year after discharge,and 168 patients remained alive within 1 year after discharge(82%).The multifactorial binary logistic regression revealed that the exacerbation over two times in the last year before admission(RR=39.613,95%CI:6.108-259.915,p<0.001),Medical Research Council Dyspnea Index(m MRC)scores> 2(RR=29.760,95%CI:4.180-211.889,p=0.001),a rise in serum Lactate Dehydrogenase(LDH)(RR=1.011,95%CI:1.004-1.019,p=0.003),detection of Pseudomonas Aeruginosa(PA)in sputum culture(RR=82.336,95%CI:2.608-2599.095,p=0.012),echocardiography indicated enlargement of the right ventricle(RR=11.314,95%CI:2.012-60.896,p=0.005)were independent risk factors for death within one year after discharge of AECOPD inpatient.Long-term Oxygen Therapy(LTOT)was an independent protective factor(RR=0.017,95%CI: 0.002-0.118,p <0.001).A regression model based on the above six variables can predict the death risk within one year after discharge for AECDPD inpatients,and the sensitivity was 77.1% and the specificity was94.5%.Area under the ROC curve was 0.972(95%CI: 0.953-0.992,p<0.001).Conclusions: The exacerbation over two times in the previous year,Medical Research Council Dyspnea Index(m MRC)scores > 2,a rise in serum Lactate Dehydrogenase(LDH),detection of Pseudomonas Aeruginosa(PA)in sputum culture,echocardiography indicates enlargement for the right ventricle were independent risk factors for death within one year after discharge of AECOPD inpatient.Long-term Oxygen Therapy(LTOT)was an independent protective factor.These variables were able to predict the risk of death within 1 year after discharge of AECOPD inpatients.