Analysis Of Risk Factors Associated With Frequent Acute Exacerbations Of Chronic Obstructive Pulmonary Disease

Objective:Frequent acute exacerbation of COPD is not uncommon in clinical practice,but there are relatively few studies on it.In this study,by analyzing the general clinical data,lung function,blood gas analysis,hematology and other indicators of frequent acute exacerbation of chronic obstructive pulmonary disease（AECOPD）and non-frequent AECOPD,the risk factors of frequent acute exacerbation of COPD were discussed.In order to identify high-risk patients with acute COPD exacerbation early,and give timely intervention to reduce the frequency of acute COPD exacerbation.Methods:A total of 515 patients hospitalized for AECOPD in the First Hospital of Lanzhou University from January 2012 to January 2022 were picked in this retrospective study,including 375 males（72.8%）and 140 females（27.2%）,with a composite life of 70.13 years.According to the number times of hospitalizations due to AECOPD in a year,the patients were divided into frequent AECOPD group（≥2times/year,n=183）and non-frequent AECOPD group（<2 times/year,n=332）.The general clinical data,pulmonary function,blood gas analysis,hematological and other indicators of acute exacerbations of COPD were collected to explore the risk factors of frequent AECOPD.Results:1.Clinical data:Pulmonary function class III/IV was more common in the frequent acute exacerbation group,while pulmonary function class I/II was more common in the non-frequent acute exacerbation group.Compared with the non-frequent exacerbations group,the frequent exacerbations group had a longer duration of COPD（P<0.05）.There were no notable distinctions in gender,age,smoking index,BMI,hypertension,coronary heart disease,and diabetes between the two groups（all P>0.05）.2.FEV₁,FEV₁%pred,FVC,FVC%pred,FEV₁/FVC,DLCO,DLCO/VA in frequent acute exacerbation group were lower than those in non-frequent acute exacerbation group（P<0.05）.RV/TLC was higher than that in non-frequent exacerbations（P<0.05）.3.Comparison of hematological indicators.There were 126 cases of typeⅠrespiratory failure,28 cases of typeⅡrespiratory failure and 30 cases of no respiratory failure in frequent acute exacerbation group.There were 200 patients with typeⅠrespiratory failure,22 patients with typeⅡrespiratory failure and 110 patients without respiratory failure in non-frequent acute exacerbation group.Compared with the non-frequent acute exacerbation group,the frequent acute exacerbation group had lower Pa O₂and Sa O₂and higher Pa CO₂（P<0.05）.There was no notable distinctions in p H between the two groups（P>0.05）.4.Comparison of hematological indicators.Compared with the non-frequent acute exacerbation group,the frequent acute exacerbation group had significant reductions in LY%and LY and significant increases in NE%,NEUT,RDW and D-dimer（P<0.05）.There was no significant difference in EOS%,EOS and fibrinogen between the two groups（all P>0.05）.5.Logistic regression analysis of risk factors for frequent acute exacerbations of COPD.Multivariate Logistic regression analysis was performed using the stepwise forward method,with frequent exacerbations as the dependent variable and the statistically significant indicators in univariate analysis as the independent variables.The results showed that low FEV₁%pred（OR=0.986,95%CI:0.976-0.996,P=0.006）,low DLCO（OR=0.884,95%CI:0.802-0.975,P=0.014）,combined with typeⅠrespiratory failure（OR=2.061,95%CI:1.271-3.341,P=0.003）,typeⅡrespiratory failure（OR=2.608,95%CI:1.238-5.494,P=0.012）,and increased RDW（OR=1.148,95%CI:1.034-1.276,P=0.010）were the risk factors for frequent acute exacerbations of COPD.6.The ROC curve model was established with FEV1%pred,DLCO,respiratory failure type and RDW as independent variables,and frequent acute exacerbation as outcome variables.The results showed that the best thresholds of FEV1%pred,DLCO,respiratory failure type and RDW for predicting frequent acute exacerbations in COPD patients were 52.91%,4.00 mmol/min/k Pa,type I respiratory failure,14.55%,69.4%and 57.8%,respectively.40.4%,80.4%,84.2%,33.1%,42.6%,78.6%,and the area under the curve（AUC）were 0.645,0.628,0.610,0.610,respectively.Conclusions:Pulmonary ventilation function and diffusion function are severely impaired,combined with typeⅠrespiratory failure,typeⅡrespiratory failure,and increased RDW are the main risk factors for frequent exacerbations of COPD,which provides help for clinical prevention of acute exacerbations of COPD.