Evaluation Of Renal Venous Stasis Index In Patients With Chronic Obstructive Pulmonary Disease Complicated With Pulmonary Hypertension

【Objective】This study aimed to investigate the sensitivity and specificity of Renal venous stasis index(RVSI)in the diagnosis of Chronic obstructive pulmonary disease(Chronic obstructive pulmonary disease)complicated with pulmonary hypertension(PH).【Methods】A total of 320 patients with chronic obstructive pulmonary disease who were admitted to the Department of Respiratory and Critical Care Medicine of the Affiliated Hospital of Yunnan University from June 2020 to December 2020 were selected as inclusion criteria according to the diagnostic criteria of the 2020 GOLD guidelines.According to the exclusion criteria,50 COPD patients who met the criteria were screened out.Pulmonary arterial systolic pressure(PASP)was calculated using tricus PID method in 50 patients.Pulmonary arterial hypertension was diagnosed when PASP≥35mm Hg,and the patients were divided into PH group(n = 20)and non-PH group(n = 30).Collect Renal venous stasis index(RVSI),pulmonary artery to aortic ratio(RPA),Red Cell Distribution Width(RPA)obtained from chest CT were collected for both groups.RDW),Forced expiratory volume in 1 second to the predicted value(FEV1%),blood oxygen partial pressure(PAO2),blood carbon dioxide partial pressure(blood carbon dioxide partial pressure),and expiratory volume in 1 second to the predicted value.PCO2),general clinical data(including age,gender,BMI,smoking history,hypertension history)from tow groups,and comparative analysis of the data collected between the two groups;The correlation between RVSI,RPA,RDW,FEV1%,Pa O2,PCO2 and pulmonary systolic pressure(PASP)was studied.ROC curve was used to analyze the role of RVSI in the evaluation of COPD complicated with pulmonary hypertension.【Results】In this study,there was no statistical difference in age,gender,smoking history,history of hypertension and BMI between the COPD group combined with p H and the COPD group without p H in general information(P > 0.05).The levels of RVSI and RPA in COPD patients with p H were higher than those in COPD patients without p H,and the difference was statistically significant(P < 0.05).The independent variables RPA and RDW were the factors affecting PASP number,while RVSI,FEV1%,Pa O2 and PCO2 were not the factors affecting PASP.both the regression coefficients(B)of RPA and RDW are positive,indicating that RPA and RDW can positively influence the numerical variation of PASP,that is,the higher the value of RPA and RDW,the greater the value of PASP.Based on the above analysis,the quantitative relationship(regression equation)between PASP,RPA and RDW can be obtained as follows: PASP=-41.419+30.477* RPA +3.523*RDW;In the diagnosis of COPD with p H,the area under the curve of RVSI was 0.669(95%CI0.494-0.844).The optimal cut-off value for RVSI in the assessment of COPD with p H was 0.041.the combined p H could be diagnosed,with sensitivity of 65% and specificity of 83.3%.The area under the curve of RPA was [0.793(95%CI0.655-0.932)],and the optimal cut-off value for RPA to evaluate the combined p H of COPD patients was 0.895.the combined p H could be diagnosed,with a sensitivity of 55% and specificity of 96.7%.In contrast,RVSI was not better than RPA in the diagnosis and assessment of COPD with p H,but the sensitivity of RVSI combined with RPA in the diagnosis of COPD with p H was 73.9%.The specificity was 88.9%,and the accuracy was higher than that of RVSI and RPA alone.【Conclusion】RVSI can be used as one of the screening and evaluation indicators of COPD with p H,but its evaluation ability is not better than that of RPA.When RVSI combined with RPA in the diagnosis of COPD with p H,its accuracy is higher than that of RVSI and RPA alone.