Risk Factors Of Heart Failure Caused By COPD And Pulmonary Heart Disease And Correlation Analysis With Erythrocyte Distribution Width

[Objective]:To study the risk factors of heart failure caused by COPD with cor pulmonale and its correlation with erythrocyte distribution width[Methods]:A retrospective study was conducted to collect 93 hospitalized patients diagnosed as COPD with pulmonary heart disease in the first affiliated hospital of kunming medical university on October 1,2017 and October 31,2019.According to the occurrence of heart failure,the patients were divided into heart failure group and non-heart failure group,COPD and pulmonary heart disease with heart failure group 29 cases,COPD and pulmonary heart disease with 64 cases.All the cases into the group of patients through unified case table,gathering the general information(age,gender,smoking index),clinical features,hospitalization days,sick time,increase time,hospitalization expenses),collected at the same time the patient's laboratory examination indexes(blood routine,blood biochemistry and arterial blood gas admission),and lung function,heart colour to exceed,chest CT related auxiliary examination index,in the form of Excel spreadsheet input relative database.using SPSS25.0 software package for data statistics analysis,screening of difference was statistically significant project.Nonconditional Logistic regression analysis was used to determine risk factors.The prediction model was established based on Logistic regression analysis results,and the predictive value of the regression model was tested by ROC curve.Correlation analysis of RDW and other factors.The risk factors of heart failure caused by COPD and pulmonary heart disease were discussed and the correlation between them and the erythrocyte distribution width was obtained.[Results]:1.Single Factor Analysis1.1 Comparison of general information There were 27 cases(93.1%)of males and 2 cases(6.9%)of females in heart failure group;There were 59(92.2%)of males and 5 cases(5.7%)of females in non-heart failure group,and had no significant difference(P>0.05);The indifference in the age between the heart failure group(66.90±10.57 years old)and the non-heart failure group(66.92±9.86 years old)was statistically significant(P>0.05).There was no significant difference in smoking index between the heart failure group(400±650 sticks/day)and the non-heart failure group(450±660 sticks/day)(P>0.05).1.2 Comparison of clinical features between the two groups There was no statistically significant difference in length of stay,duration of illness and aggravation time between the heart failure group and the non-heart failure group(P>0.05).The hospitalization expense of the heart failure group was higher than that of the non-heart failure group(18671.11±7254.28 yuan),and the edema of lower limbs(75.9%)was higher than that of the non-heart failure group(39.1%),with statistically significant differences(P<0.05).1.3 Comparison of laboratory examination results between the heart failure group and the non-heart failure group It showed that the d-d and PLT of the heart failure group was higher than that of the non-heart failure group,and the WBC,N%and PCT of the heart failure group were lower than that of the non-heart failure group,with no statistically significant difference(P>0.05).RDW,RBC,HB,HCT,PT,APTT and HsCRP in the heart failure group were higher than those in the non-heart failure group,while ALB and FIB were lower than those in the heart failure group,with statistically significant differences(P<0.05 or P<0.01).1.4 Comparison of types of arterial blood gas and respiratory failure between the two groups In the arterial blood gas analysis of hospitalized patients in the two groups,compared with the non-heart failure group,PaCO2[(50.00±13.0)mmHg versus(43.05±16.92)mmHg]and PO2[(65.00±28.10)versus(53.00±22.83)]showed statistically significant differences(P<0.05),and OI was higher than that of the non-heart failure group,with no statistically significant differences(P>0.05).Heart failure and heart failure group comparison,I type of respiratory failure rate(13.8%and 39.1%),? respiratory failure rate(75.9%and 43.8%),the difference was statistically significant(P<0.05).1.5 Comparison of the results of color doppler echocardiography between the two groups There was no significant difference in forced expiratory volume/forced vital capacity(FEV1/FVC)between the heart failure group and the non-heart failure group(P>0.05).The percentage of forced expiratory volume in the first second(FEV1%pred)[(36.70±10.45)and(44.80±19.00)]was statistically significant(P<0.05).1.6 The results of the two groups were compared The difference of right ventricular diameter[(45.34±4.75)and(37.81±5.00)mm],pulmonary artery pressure[(68.48±21.83)and(53.25±20.34)mmHg],and right ventricular outflow tract[(30.00±3.00)and(29.00±8.00)mm]was statistically significant between the heart failure group and the non-heart failure group,while the difference of right ventricular outflow tract between the two groups was not statistically significant(P>0.05).1.7Chest CT imaging suggested comparison of pleural effusion between the two groups CT imaging showed that pleural effusion in the heart failure group(31%)was higher than that in the non-heart failure group(9.4%),with statistically significant difference(P<0.05).2.Independent risk factors for COPD with cor pulmonale combined with heart failure2.1Logistic regression analysis of risk factors for COPD with cor pulmonale combined with heart failure By multivariate binary logistic regression analysis and excluding confounding factors,the independent risk factors for COPD with cor pulmonal disease combined with heart failure were obtained:Red blood cell distribution width(OR=1.459,95%CI=1.173-1.814,P=0.001),right atrial diameter(OR=1.327,95%CI=1.034-1.704,P=0.026).2.2ROC curve tests the predictive value of RDW With the occurrence of heart failure as the state variable,RDW as the test variable,the ROC curve was compiled,and the predictive value of the regression model was tested by the ROC curve.ROC curve analysis showed that area under the curve(AUC)=0.759,(95%ci:0.659-0.859)RDW was 14.5%as the critical value.When RDW>was 14.5%,the sensitivity and specificity of RDW in detecting COPD pulmonary heart disease with heart failure were 79.3%and 62.5%respectively.3.3.Correlation analysis between RDW and other factors Using Pearson correlation analysis:RDW and COPD and cor pulmonale patients age,smoking index,hospitalization expenses and hospitalization days,sick time,aggravating,platelets,white blood cells,neutrophils%D-dimer prothrombin time,fibrinogen,albumin,right ventricular outflow tract,right ventricular diameter,right room inside diameter,the EV1/FVCFEV1%is expected value,hypersensitive c-reactive protein and calcitonin original correlation has no statistical significance(P>0.05).RDW and COPD and pulmonary heart disease patients with blood routine(red blood cell,hemoglobin,hematopoiesis),activated part of thromboactivase time,pulmonary artery pressure,heart failure index nt-probnp inverse ratio,and COPD and pulmonary heart disease patients with oxygen partial pressure,oxygenation index,carbon dioxide partial pressure,the difference was statistically significant(P>0.05).[Conclusion]:1.RDW and right atrial diameter are independent risk factors for COPD with cor pulmonale combined with heart failure.RDW can be used as a serological indicator for COPD complicated by heart failure.2.RDW can be used as an evaluation index of coagulation dysfunction,increased blood viscosity and hypoxemia in patients with COPD and pulmonary heart disease.