Analysis Of Clinical Characteristics Among Patients With Common Phenotypes Or GOLD Groups C,D Admitted For Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Objective:Currently,little is known about the clinical characteristics of the common phenotypes and distribution of different GOLD groups in patients with acute exacerbation of chronic obstructive pulmonary disease?AECOPD?.Differences in clinical data among AECOPD patients with three common phenotypes,namely,Chronic Bronchitis?CB?,Emphysema?EM?and Asthma-COPD Overlap?ACO?definited according to the 2019 COPD GOLD guidelines were compared,the proportion of GOLD groups C,D and related clinical characteristics in patients with those common phenotypes were analyzed in this study purposing to provide theoretical and practical references for personalized treatment of COPD.Methods:The clinical data of 199 AECOPD patients admitted to the department of respiratory and critical care medicine or emergency medicine,first affiliated hospital of Wannan Medical College from January 2018 to December 2019 were retrospectively analysis.Subjects were divided into CB,EM or ACO groups according to the phenotype definition,the differences of clinical data?including COPD assessment test?CAT?,modified British Medical Researh Council questionnaire?mMRC?,and numbers of hospitalizations for acute exacerbation?were compared.Furthermore,group C and D were classified in accordance with the 2019 GOLD“ABCD”assessment tool.The distribution ratios of group C and D in the three phenotypes were analyzed;basic clinical data,laboratory indicators,and imaging indicators were compared between group C and D.Results:1.The ratios of phenotype composition among 199 AECOPD patients were:CB?59%?,EM?25%?and ACO?16%?,respectively.More men?p=0.010?,older?p=0.004?,longer duration of disease?p=0.004?,longer hospital stay?p=0.004?,higher levels of D-dimer?p=0.017?,fibrinogen?p=0.001?,CAT scores?p=0.000?,mMRC?p=0.001?and tracheal wall thickness scores?p=0.009?;in addition,higher proportion of hypertension were seen in subjects with CB phenotype,when compared with clinical data of patients with EM or ACO phenotypes.Compared to CB or ACO phenotypes,group EM has a lower pH?p=0.007?.Relative to the other two phenotypes,patients with ACO phenotype had higher prealbumin?p=0.001?,eosinophil count?p=0.005?and BMI?body mass index,p=0.000?;but lower PaCO2?p=0.001?.Regression analysis showed that age?OR=1.142,p=0.009?and PaCO₂?OR=1.097,p=0.000?were two independent risk factors for acute exacerbations of subjects with EM.2.Groups C and D in 199 cases of AECOPD patients accounted for 31.2%,68.8%,respectively,according to the GOLD“ABCD”assessment tool.Compared with group C,more smokers?p=0.028?,older?p=0.000?,longer duration of disease?p=0.001?and hospital stay?p=0.000?;higher levels of inflammation indicators(white blood cell count?p=0.023?,NLR?ratio of neutrophils to lymphocytes,p=0.001?,eosinophil?p=0.012?,C-reactive protein?p=0.000?,erythrocyte sedimentation rate?p=0.001?,procalcitonin?p=0.004?,cystatin-c?p=0.004?;higher amount of fibrinogen?p=0.000?,D-dimer?p=0.002?and PaCO2?p=0.028?;higher tracheal wall thickness scores?p=0.000?;while lower prealbumin?p=0.000?,BMI?p=0.000?presented in group D.There were no significant difference in comorbidities between the two groups.The proportion of groups C and D in patients with Chronic Bronchitis?CB?,Emphysema?EM?and Asthma-COPD Overlap?ACO?phenotypes was statistically significant?p=0.000?,among which ratio of group D was the highest in patients with CB.3.There were older?p=0.019?,longer hospital stay?p=0.042?,higher eosinophil count?p=0.003?,C-reactive protein?p=0.014?,erythrocyte sedimentation rate?p=0.036?,cystatin-C?p=0.019?,fibrinogen?p=0.027?,and higher tracheal wall thickness scores?p=0.020?;while lower in prealbumin?p=0.032?and BMI?p=0.003?in group D than in group C of CB phenotype patients.4.Relative to group C,patients with EM phenotype in group D were older?p=0.040?,had longer hospital stays?p=0.030?,higher levels of inflammation indicators such as C-reactive protein?p=0.038?,erythrocyte sedimentation rate?p=0.043?;but lower prealbumin?p=0.029?,BMI?p=0.018?.5.Compared with group C,older?p=0.038?,longer hospital stays?p=0.030?,higher levels of white blood cell count?p=0.047?,NLR?p=0.006?,eosinophil?p=0.007?,blood platelet count?p=0.029?,pH?p=0.019?and PaCO2?p=0.033?were seen in group D patients from ACO phenotype.Conclusions:The clinical characteristics of AECOPD patients with different phenotypes and their GOLD grouping were different.Clarifying the clinical,laboratory,and imaging characteristics in patients with different phenotypes and their GOLD groups will contribute to provide a more in-depth theoretical reference for individualized and accurate treatment of patients hospitalized for AECOPD.