Predictive Value Of Heparin Binding Protein In Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

BackgroundChronic obstructive pulmonary disease is a common respiratory disease that seriously endangers human health.By 2020,COPD will be the fifth disease ranked by economic burden and the third disease leading cause of death worldwide.China has surveyed 20,245 adults in 7 regions,and the prevalence of chronic obstructive pulmonary disease in people over 40 years old is as high as 8.2%.Chronic obstructive pulmonary disease patients have an acute exacerbation of about 0.5 to 3.5 times per year.Acute exacerbation of chronic obstructive pulmonary disease is the most important factor in the death of patients with chronic obstructive pulmonary disease,and is also the main part of medical expenses for patients with chronic obstructive pulmonary disease.Domestic research suggests that the average hospitalization cost of patient with chronic obstructive pulmonary disease is as high as 11,598 yuan.In particular,patients who died of acute exacerbation of chronic obstructive pulmonary disease experienced a significant increase in medical expenditure during the last hospitalization period,which was related to the high cost of life support and other treatment measures.The most important and common cause of acute exacerbation of chronic obstructive pulmonary disease is infection.Among them,bacterial infection accounts for the vast majority.The Global Initiative for Chronic Obstructive Lung Disease guidelines have recommended antibiotics when patients have three cardinal symptoms: 1.increase in dyspnea,sputum volume,and sputum purulence;2.or have two of the cardinal symptoms,and the purulence of sputum is necessary in both two symptoms;3.or require mechanical ventilation.At present,the clinical application of some common biomarkers such as: procalcitonin,C-reactive protein,erythrocyte sedimentation rate,white blood cell count and other biological indicators.These biomarkers can help guide the management and treatment of patients with acute exacerbation chronic obstructive pulmonary.Among them,the predictive effect of procalcitonin is better in bacterial infection.But we found that heparin-binding protein levels in patients with acute exacerbation of chronic obstructive pulmonary disease were significantly elevated.Therefore,we studied the predictive value of heparin-binding protein,procalcitonin and C-reactive protein in patients with acute exacerbation of chronic obstructive pulmonary disease.ObjectiveIn order to study the predictive value of heparin-binding protein,procalcitonin and C-reactive protein in patients with acute exacerbation of chronic obstructive pulmonary disease.MethodsAccording to the COPD and AECOPD diagnostic criteria guided by the 2018 Global Initiative for Chronic Obstructive Pulmonary Disease(GOLD),110 patients with AECOPD were enrolled in our hospital of Pneumology Department for the past 1 year,including 80 patients in the AECOPD group.They were divided into three subgroups according to the symptom and Expert Consensus of Clinical Application of Mechanical Ventilation.Subgroup type ?: no purulence of sputum without mechanical ventilation;type ?: purulence of sputum without mechanical ventilation;type ?: mechanical ventilation group required;And 30 patients with stable COPD as control group;Procalcitonin,heparin-binding protein and C-reactive protein were detected and collected in these 110 patients in order to statistical analysis.ResultsCompared with the stable COPD group,heparin-binding protein,procalcitonin and C-reactive protein in AECOPD group were all significantly increased,the difference was statistically significant(P < 0.05).We use ROC curve to predict value of these three biomarkers on acute exacerbation of chronic obstructive pulmonary disease.Compared with the stable COPD group,the area under the curve of heparin-binding protein was 0.940,followed by procalcitonin was 0.881,and finally C-reactive protein was 0.720.Logistic regression analysis was performed on these three biomarkers to obtain the probability P value.The combined ROC curve of the three biomarkers was analyzed by probability P value.The area under the curve was 0.985.In the three subgroups of AECOPD type ?,type ? and type ? the difference between these four groups of heparin-binding protein,procalcitonin,and C-reactive protein was statistically significant(P < 0.05);Moreover,we found that heparin-binding protein,procalcitonin and C-reactive protein levels were gradually increased in these four groups.Lowest in the stable COPD group and the highest in the AECOPD type ? group.Conclusion1.Heparin-binding protein,procalcitonin and C-reactive protein have redictive value for acute exacerbation of chronic obstructive pulmonary isease,with heparin-binding protein being the most;And the joint test of hree biomarkers has excellent predictive value,which is better than anyone.2.In those patients with purulence of sputum or required mechanical entilation treatment,moreover,the level of heparin-binding protein,procalcitonin and C-reactive protein are significantly increased.Antibiotic reatment should be considered according to GOLD guidelines in these patients.Our study believes that these patients may benefit from antibiotic therapy.