Evaluation Of Mechanical Ventilation And Prognosis In Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease By Four Scoring Systems

Chronic obstructive pulmonary disease(COPD)is a common respiratory disease characterized by persistent respiratory symptoms and restricted airflow.Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)refers to the rapid deterioration of respiratory symptoms in patients requiring further treatment,which is an important cause of death.Severe AECOPD patients often need mechanical ventilation,but even with mechanical ventilation,some critically ill patients still have a higher risk of death.Mechanical ventilation is an effective respiratory support method for AECOPD patients,and the clinical efficacy is affirmed,but the risk of death in some critically ill patients is still high.If the critical degree of AECOPD patients can be assessed by objective scoring scale at an early stage,it will be helpful for clinicians to judge the development trend of patients' condition in time,arouse enough attention,make sufficient preparations in advance,intervene and adjust the treatment plan,so as to improve the prognosis and improve the quality of life of patients.Objective:To study the scores of CAPS,BAP-65,AECOPD-F and DECAF in evaluating mechanical ventilation(MV)and prognosis patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:The clinical data,laboratory data and imaging data of 323 patients with AECOPD at admission were collected,and the CAPS score,BAP-65 score,AECOPD-F score and DECAF score were calculated respectively.SPSS software was used to analyze the predictions of four scoring systems on the rate of mechanical ventilation,the days of mechanical ventilation,the mortality rate of mechanical ventilation patients during hospitalization,and to compare the value of four scoring systems in evaluating patients mechanical ventilation and prognosis.Results:1.The CAPS score,BAP-65 score,AECOPD-F score and DECAF score of mechanical ventilation group are higher than those of non-mechanical ventilation group,the difference is statistically significant(P<0.05);With the increase of scores of each scoring system,the patient's mechanical ventilation rate increased,CAPS score ? 20 points,BAP-65 score ? 3 points,AECOPD-F score ? 4 points,DECAF score ? 3,the patient's mechanical ventilation rate is higher,respectively: 34.9%,43.4% 39.2%,40.0%;The AUROC of CAPS,BAP-65,AECOPD-F,and DECAF for mechanical ventilation are 0.615,0.711,0.769,and 0.703,respectively.The AUC of the CAPS score is smaller than the other three scores,all P<0.05,with significant difference.There is no significant difference between the other two scores.2.The four scores are positively correlated with the days of mechanical ventilation in AECOPD patients(P < 0.05).3.The scores of CAPS,BAP-65,AECOPD-F and DECAF in the death group of mechanical ventilation patients are higher than those in the survival group of mechanical ventilation patients,and the difference is statistically significant(P<0.05).With the increase of the scores of each scoring system,the mortality rate of mechanical ventilation patients increased.CAPS score ? 27,BAP-65 score ? 4,AECOPD-F score ? 6 points,DECAF score ? 4 points,mechanical ventilation patients with higher mortality,respectively: 41.2%,43.8%,38.5%,52.6%;The AUROC of CAPS,BAP-65,AECOPD-F and DECAF are 0.669,0.703,0.714 and 0.886 respectively.The AUC of DECAF is higher than the other three scores,all P < 0.05,with significant difference.There is no significant difference between the other two scores.Conclusion:1.The higher the scores of CAPS,BAP-65,AECOPD-F and DECAF at admission,the higher the rate of mechanical ventilation,the duration of mechanical ventilation and the mortality rate of mechanical ventilation patients during hospitalization.2.Four scoring systems have certain predictive value for evaluating the prognosis of AECOPD patients undergoing mechanical ventilation,among which CAPS scoring system is relatively poor in predicting the mechanical ventilation rate of patients;DECAF scoring is more convenient,practical and accurate in evaluating the prognosis of mechanical ventilation patients.