Factors Related To Death And The Three Score Clinical Application Research About Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Objective:To analyze factors related to death and to explore the value of the CURB-65score?the BAP-65 score ?the DECAF score evaluating the prognosis with acute exacerbation of chronic obstructive pulmonary disease.Method:To analyze the clinical data of 302 cases of AECOPD patients in our hospital from respiratory department retrospectively.we collected the clinical data and laboratory data in 24 hours after admission.According to survive conditions,the 302 patient are divided into death and survival group,and then compare the differences between the two groups in all clinical data,analyze risk factors related to death and respectively calculated The CURB-65 score,The BAP-65 score,The DECAF score.then compare the difference of the CURB-65,the BAP-65,the DECAF of two groups.Each scale is grouped by their own scores,and calculate the respective mortality.the prediction value of the scores on hospital mortality was evaluated through ROC curve.Result:1.Single analyze show AECOPD patients death group in merger with pulmonary consolidation,atrial fibrillation,high degree of difficulty in breathing,disturbance of consciousness on the percentage of people were all more than survival,death patients in arterial blood eosinophils count,PH,albumin,FEV1 % level index was lower than survival group,The death group had the higher of the neutrophils percentage and c-reactive protein than survival group,and the differences were significant(P<0.05).Death and survival group were similar in age,white blood cells numerical,hemoglobin,fibrinogen,D-dimer,PaO2,PaCO2,creatinine,blood urea nitrogen,smoking history aspects,there was no statistically significant difference(P>0.05).2.Multiple factors analysis found that patients with severe dyspnea,disturbance of consciousness,with pulmonary consolidation,atrial fibrillation,low level of albumin,eosinophils reduced,acidosis,high CRP levels for patients was the independent risk factors of death.3.The average scores of death group and the survival group had statistical significance in CURB-65 scores,BAP-65 scores,DECAF scores(P<0.05).4.With the increase of scores,hospital mortality increase correspondingly.In the patients whose DECAF and CURB-65 score were more than four points above,the hospital mortality48%,50%,and BAP-65 score was more than four points,the hospital mortality was 80%.5.The area under the receiver operating characteristic curve of CURB-65 and BAP-65 were above 0.80,the AUROC of DECAF was 0.95.By Z test respectively,the results show that there was no statistical significance(P>0.05)in compare CURB-65 score with BAP-65 score,DECAF respectively compared with CURB-65 and BAP-65,the difference was statistically significant(P<0.05).Conclusion:1.The patients of AECOPD who with pulmonary consolidation or atrial fibrillation or acidosis,had high degree of dyspnea and disturbance of consciousness,had high c-reactive protein or had the low level of albumin and eosinophils can certain extent reflect poor prognosis of patients.2.CURB-65,BAP-65,DECAF score on admission has value in predicting hospital mortality rate of acute exacerbation of chronic obstructive pulmonary disease,the degree of DECAF score have the highest accuracy in terms of prognosis prediction among three scores,it worth wide use.