Hematological Parameters And Short-term Readmission Risk In Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

[Purpose] We aimed to identify the relationship between hematologic parameters and increased risk of readmission in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)patients.[Methods] A retrospective analysis of clinical and laboratory features of 603 patients with AECOPD who were admitted to the Liyuan Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology on January 1,2018 solstice and June 1,2020.Independent sample t test and chi-square test were used to compare the characteristics between groups of data with normal distribution,and Mann-Whitney test was used to compare the characteristics of variance inconsistencies or non-normal distribution.Receiver operating characteristic(ROC)curve was used to assess the predictive power and cutoff value of hematological parameters for the increased risk of short-term readmission in patients with AECOPD.Multivariate logistic regression analysis was used to identify factors that were independently associated with an increased risk of short-term readmission after discharge in patients with AECOPD.Spearman correlation analysis was used to evaluate the relationship between WBC,RDW,NLR,PLR and PDW and CRP and PCT.[Results] 1.603 patients hospitalized for AECOPD during January 1,2018 and June 1,2020 were included in our study.The median age of all participants was 70 years old,IQR(63-78 years old)and 79.3% were male.The proportion of the patients with previous smoking history was 39.5%,and the current smoking rate was 25%.2.Multivariate logistic regression analysis showed that ICU admission(P<0.001,OR: 12.102,95% CI: 3.401,43.057),increased neutrophil-to-lymphocyte ratio(P<0.001,OR: 1.069,95% CI: 1.033,1.106)and PCT>0.05(P=0.002,OR: 1.941,95% CI: 1.271,2.966)were independent predictors of prolonged hospital stay in patients with AECOPD.3.Spearman correlation analysis showed that White blood cell(WBC)count was positively correlated with CRP(r = 0.411**,p< 0.001)and procalcitonin(PCT)(r = 0.375**,p< 0.001),NLR was positively correlated with C-reaction protein(CRP)(r = 0.510**,p< 0.001)and PCT(r = 0.438**,p< 0.001),platelet-lymphocyte ratio(PLR)was positively correlated with CRP(r = 0.360**,p< 0.001),p< 0.001)and PCT(r = 0.257**,p< 0.001)also expressed a positive correlation.4.NLR(p=0.001),PLR(p=0.018),PDW(p=0.019),and CRP(p=0.010)were higher in the 30-day readmission group than in the 30-day readmission group.Multivariate logistic regression analysis showed that increased NLR(p<0.001),and PDW(p<0.001)were independently associated with an increased risk of 30-day readmission in patients with AECOPD.5.WBC(p=0.048),red cell distribution width(RDW)(p=0.039),NLR(p<0.001),PLR(p=0.023),platelet distribution width(PDW)(p=0.005)and CRP(p=0.006)were significantly higher in patients who had been readmitted within 60 days than who had not been readmitted within 60 days.Multivariate logistic regression analysis showed that increased RDW(p=0.004),NLR(p<0.001),and PDW(p<0.001)were independent predictors of an increased risk of 60-day readmission in patients with AECOPD.[Conclusions] 1.ICU admission,elevated NLR and PCT>0.05 were independent predictors of prolonged hospital stay in patients with AECOPD.2.WBC count,NLR and PLR levels were positively correlated with inflammation markers CRP and PCT in patients with AECOPD.3.NLR,PLR,PDW,and CRP were higher in the 30-day readmission group than in the non-readmission group,and increased NLR,and PDW were independently associated with an increased risk of 30-day readmission in patients with AECOPD.4.WBC,RDW,NLR,PLR,PDW,and CRP in the 60-day readmission group were higher than those in the 60-day readmission group,and elevated RDW,NLR,and PDW were independent predictors associated with an increased risk of 60-day readmission in patients with AECOPD.