Analysis Of The Risk Factors Of Acute Exacerbation Of Chronic Obstructive Pulmonary Disease Complicated With Pulmonary Thromboembolism

Objective:To explore the risk factors of acute exacerbation of chronic obstructive pulmonary disease(COPD)complicated with pulmonary thromboembolism(PTE),so as to enhance the diagnosis awareness of patient with AECOPD complicated with PTE,improve prognosis and reduce the risk of death.Methods:One hundred and twenty seven patients with acute exacerbation of COPD who underwent CT pulmonary angiography(CTPA)or radionuclide pulmonary ventilation/ perfusion imaging from January 2015 to August 2019 in the Second Hospital of Jilin University were collected.According to the results of CTPA or radionuclide pulmonary ventilation / perfusion imaging,45 patients diagnosed PTE were identified as the observation group,82 patients without PTE were identified as the control group.By comparing the basic data,previous history and basic diseases,clinical symptoms and signs,laboratory examination and other clinical data of the two groups,and exploring the risk factors of patients with AECOPD complicated with PTE by using multivariate logistic regression analysis.Using the receiver operating characteristic curve(ROC)to analyze indicators with certain diagnostic or predictive value.The results were analyzed by using SPSS 25.0 statistical software.Results:1.Analyze the basic data between the two groups.According to the established criteria,there are 127 patients including 63 males and 64 females.Among them,45 patients in AECOPD complicated with PTE,including 25 males and 20 females,with an average age of 69.16 ± 9.90 years;82patients in simple AECOPD,including 38 males and 44 females,with an average age of 72.21 ± 9.71 years.There was no significant difference in gender composition,agedistribution and smoking history between the two groups(P(29)0.05).2.Analyze the medical history.The AECOPD complicated with PTE group had a significantly higher proportion of patients with previous venous thromboembolism,malignant tumor and bed rest time?1 week compared to that in simple AECOPD group(P(27)0.05).However,there was no significant difference between the two groups in hypertension,coronary heart disease,diabetes,cerebrovascular disease,pulmonary hypertension,arrhythmia and other indicators(P(29)0.05).3.The clinical symptoms and signs.There was significantly higher incidence of hemoptysis,lower extremity asymmetric swelling,and deep vein thrombosis(DVT)in AECOPD complicated with PTE group compared with that in simple AECOPD group.The incidence of expectoration in AECOPD complicated with PTE group was less than that in simple AECOPD group.The difference of the above indexes between the two groups was statistically significant(P(27)0.05).However,dyspnea,fever and other indicators were not statistically significant between the two groups(P(29)0.05).4.Comparison of the laboratory examination between the two groups.The levels of D-dimer,C-reaction protein(CRP),white blood cell(WBC),monocyte count,D-D/ FIB and platelet distribution width(PDW)in AECOPD complicated with PTE group were higher than those in simple AECOPD group,while the levels of PaO2 and PaCO2 in AECOPD complicated with PTE group were lower than those in simple AECOPD group.The difference of the above indexes between the two groups was statistically significant(P(27)0.05).But there was no statistical difference in fibrinogen(FIB),troponin,myoglobin,creatine kinase isoenzyme(CK-MB),brain natriuretic peptide(BNP),neutrophil percentage,hemoglobin(HGB),hematocrit(HCT)and platelet(PLT)between the two groups(P(29)0.05).5.Multivariate logistic regression analysis.The results showed that combined with bed rest time?1 week,malignant tumor,lower extremity deep vein thrombosis were independent risk factors for patients with AECOPD whose complicated with PTE.6.The results of ROC curve analysis.The results showed that the best cut-off value of D-dimer was 2.625ug/ml,and the AUC was 0.820(95%CI: 0.738-0.903,P<0.001),the sensitivity and specificity were 80.0% and 81.7%,respectively.The best cut-off value of PDW was 14.2%,and the AUC was 0.618(95%CI: 0.521-0.714,P=0.029),the sensitivity and specificity were 93.3% and 39.0%,respectively.Conclusions:1.Combined with bed rest time ? 1 week,malignant tumor,lower extremity deep vein thrombosis were independent risk factors for patients with AECOPD whose complicated with PTE.Early detection in clinical diagnosis and treatment can help to decrease the misdiagnosisand missed diagnosis.2.Significantly increased D-dimer and CRP,and significant hypoxemia may suggesst that the patients with AECOPD whose complicated with PTE.