Predictive Value Of MPV,PDW Combined With D-dimer In Acute Exacerbation Of Chronic Obstructive Pulmonary Disease With Pulmonary Thromboembolism

Background and purposeChronic obstructive pulmonary disease is an independent risk factor for pulmonary thromboembolism(PTE).The incidence of PTE in patients with AECOPD is 3 times higher than that in patients without chronic obstructive pulmonary disease.The symptoms are similar to those of pure AECOPD.It is difficult to distinguish,and it is easy to miss the diagnosis,which result in delayed treatment and poor prognosis.AECOPD combined with PTE lacks specific biomarkers for diagnosis.The concentration of D-dimer < 0.5mg/L is usually used as a standard for excluding PTE,but there are many factors affecting the level of D-dimer,and the specificity is poor.Therefore,it is necessary to evaluate PTE in combination with other indicators.Mean platelet volume(MPV)and platelet distribution width(PDW)can indirectly reflect the activation of platelets and play an important role in thrombus formation.Foreign studies have shown that MPV and PDW in patients with PTE are elevated,which has certain predictive value for the recurrence of PTE.However,there are few studies on AECOPD combined with PTE for MPV,PDW and D-dimer.This paper analyzes related risk factors in AECOPD combined with PTE,and to explore the predictive value of MPV,PDW combined with D-dimer for AECOPD combined with PTE.Methods46 cases of AECOPD and PTE patients admitted to the First Affiliated Hospital of Zhengzhou University from January 2014 to December 2017 were selected as the study group.142 patients with AECOPD who were hospitalized at the same time were selected as the control group,and the clinical results of the two groups were compared.Symptoms,complications,common hematological parameters,analysis of risk factors for AECOPD combined with PTE,and to explore the diagnostic value of MPV,PDW combined with D-dimer for AECOPD combined with PTE.All data were analyzed by SPSS 23.0 statistical software,and P<0.05 considered the difference to be statistically significant.Results1.AECOPD combined with PTE patients with chest pain symptoms,pulmonary hypertension and deep vein thrombosis were more likely to be higher than the AECOPD group alone,and the difference was statistically significant(P<0.05).2.On the hematological parameters,AECOPD combined with PTE group MPV,PDW,D-dimer,arterial oxygen partial pressure,arterial blood carbon dioxide partial pressure,lactic acid,procalcitonin,and N-terminal brain natriuretic peptide precursor were higher than AECOPD group,the difference was statistically significant(P<0.05).MPV and PDW were positively correlated with D-dimer and negatively correlated with total platelet count,and the difference was statistically significant(P<0.05).3.Multivariate logistic regression analysis showed that MPV(OR=1.756 P<0.05),PDW(OR=1.580 P<0.05)and D-dimer(OR=6.286 P<0.05)were independent risk factors for predicting AECOPD with PTE.Arterial Blood oxygen partial pressure is a protective factor.4.The areas under the ROC curve of MPV,PDW,D-dimer,MPV combined with D-dimer,PDW combined with D-dimer for AECOPD combined with PTE were 0.756,0.680,0.790,0.857,0.805,respectively.The optimal cut-off points of MPV,PDW,and D-dimer are 9.05 fL,16.75%,1.184 mg/L,respectively.When the ratio is greater than the optimal cut-off point,the probability of AECOPD combining PTE is high;The sensitivity of D-dimer combination MPV was 84.9% and the specificity was 80.6%,which was greater than D-dimer alone.The sensitivity of D-dimer combined with PDW was 62.5%,the specificity was 87.1% and its specificity was significantly greater than D-dimer alone,but the sensitivity is reduced.Conclusions1.AECOPD combined with PTE patients are often accompanied by chest pain symptoms,pulmonary hypertension and deep venous thrombosis of both lower extremities.2.D-dimer combined with MPV,PDW can improve the sensitivity and specificity of AECOPD combined with PTE,and the predicted value is greater than D-dimer alone.