The Diagnostic Value Of MLPR On Acute Exacerbation Of Chronic Obstructive Pulmonary Disease Combined With Pulmonary Embolism

Objective:To evaluate the value of monocyte to large platelet ratio(MLPR)as a diagnostic tool for pulmonary embolism(PE)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)through retrospective analysis.Methods:1.We collected retrospectively the data of patients admitted to the hospital from January 2017 to January 2019.A total of 173 patients had moderate to high probability of pulmonary embolism according to the revised Geneva score and had underwent CTPA.Among them,78 patients were found with pulmonary embolism by CTPA and recorded as the AECOPD+PE group,95 patients were excluded from pulmonary embolism by CTPA and recorded as the AECOPD group.81 cases who were admitted to our department for medical examination at the same time and had no chronic lung disease,blood and immune system diseases were selected and recorded as the control group.We collected clinical data of each group including gender,age,monocyte count(MONO),platelet count(PLT),mean platelet volume(MPV),platelet-large-cell ratio(P-LCR),large platelet count(LPC),monocyte to large platelet ratio(MLPR).SPSS 26.0 software was used to analyze the data and compare the differences among the groups.2.The following data were collected additionally in the AECOPD+PE group and the AECOPD group:D-dimer(DD),procalcitonin(PCT),interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP),N-terminal B-type natriuretic peptide precursor(NT-proBNP),FEV1/FVC and FEV1%predicted after bronchodilator inhalation,history of smoking,history of hypertension,history of coronary heart disease,history of atrial fibrillation,history of heart failure,history of diabetes,history of stroke,history of previous pulmonary embolism,history of deep vein thrombosis(DVT),history of malignant tumors,recent 1 month history of fractures and surgery,swelling and pain in the lower limbs,with or without lung infection,heart rate(HR),blood oxygen saturation(SpO2),body mass index(BMI),etc.,while were analyzed and compared.And the receiver operating characteristic(ROC)curves of the MLPR and DD of the AECOPD+PE group and the AECOPD group were drawn to compare their diagnostic value for pulmonary embolism.Results:1.There was no significant difference in the basic data such as gender and age among the AECOPD+PE group,AECOPD group and control group in this study(P>0.05).There was no significant difference in the severity of pulmonary function airflow limitation between the AECOPD+PE group and the AECOPD group(P>0.05).The comparison between the two groups showed that MLPR and MONO in the AECOPD+PE group were higher than those in the AECOPD group and the control group,with a significant difference(P<0.017).The LPC of the AECOPD+PE group was lower than that of the AECOPD group and the control group,the difference was statistically significant(P<0.017).There were no significant differences in MLPR,MONO,and LPC between the two groups in the AECOPD group and the control group,with no statistical significance(P>0.017).2.Taking CTPA test results as the gold standard for diagnosis of pulmonary embolism,the AECOPD+PE group and the AECOPD group as the research objects,the ROC curves showed that the area under the curve(AUC)of MLPR to diagnose of pulmonary embolism was 0.881±0.027(95%CI:0.828?0.933,P<0.001),and the best cutoff value was 1.035%,the sensitivity was 82.1%,the specificity was 85.3%.The diagnostic value was significantly higher than DD(AUC 0.615±0.043;95%CI:0.531?0.699,P<0.001).3.Taking the AECOPD+PE group and the AECOPD group as the research object,Kappa consistency test showed that MLPR to diagnose pulmonary embolism had a strong consistency(K=0.673;95%CI:0.577?0.769,P<0.001)compared with CTPA,which was better than DD(K=0.178;95%CI:0.053?0.303,P<0.05).4.Multivariate logistic regression analysis showed that age(OR=1.059;95%CI:1.003?1.118,P<0.05),heart failure(OR=2.784;95%CI:1.182?6.554,P<0.05),and DVT(OR=4.199;95%CI:1.059?16.653,P<0.05)are the factors that affect the MLPR value.Conclusions:1.Large platelets are consumed significantly during pulmonary embolism.2.There seems to be some correlation between monocytes and pulmonary embolism.3.MLPR is a relatively reliable,convenient,cheap and widely available indicator for helping to distinguish whether AECOPD patients have pulmonary embolism.4.Age,heart failure,and DVT are risk factors that cause MLPR value to rise.