Comparison Of Clinical Features And Prognosis Of Patients With Different Exacerbation Phenotypes Of AECOPD

Objective:The clinical characteristics and prognosis of patients with different exacerbation phenotypes of AECOPD were compared,and the predictive value of relevant biomarkers for hospital readmission due to acute exacerbation within one year after discharge was evaluated,so as to guide early intervention and reduce the risk of acute exacerbation.Methods:Inpatients aged 40-80 who were diagnosed with AECOPD in the Department of Respiratory and Critical Care Medicine of the First Hospital of Lanzhou University from January 1,2021 to December 31,2021 were selected,and the basic information of the patients,smoking history,m MRC dyspnea grade,laboratory tests,lung function,complications,comorbidities,treatment(oxygen therapy,antibiotic use,and cumulative dose of systemic glucocorticoid use during hospitalization)were collected.Hospitalization(number of admissions due to acute exacerbations within 1 year before hospitalization,length of hospital stay,and whether readmission due to exacerbations within 1 year after discharge)and other relevant indicators.Based on the results of routine blood tests within 24 hours of admission,patients were divided into three groups: EOS exacerbation phenotype group(EOS%≥2% or EOS count ≥200 cells/μL),NEUT aggravated phenotype group(NEUT%≥70% or NEUT count ≥7000 cells/μL)and oligocytosis aggravated phenotype group(EOS%<2%,EOS count <200 cells/μL,NEUT%<70% and NEUT count <7000 cells/μL).SPSS Statistics 25.0 statistical software was used to compare the differences of the above indicators between the three groups,and evaluate the predictive value of peripheral blood EOS%,EOS count,NEUT%,NEUT count,NLR and PLR on the readmission of patients due to acute exacerbation within 1 year after discharge.Results:A total of 229 patients with AECOPD were enrolled,including 82(35.8%)in the EOS exacerbation phenotype,97(42.4%)in the NEUT exacerbation phenotype,and 50(21.8%)in the oligocytic exacerbation phenotype group.Data statistical analysis showed that: 1.Baseline data: Compared with the EOS exacerbation phenotype and oligocytic aggravation phenotype,the NEUT aggravated phenotype group was more likely to have m MRC dyspnea grade ≥ grade 2,NLR and PLR were higher,and the cumulative dose of systemic glucocorticoids was larger.Readmission due to exacerbations within 1 year after discharge was more likely(all P<0.05),the NEUT exacerbation phenotype group had higher PCT,longer hospital stay,and more admissions for exacerbations within 1 year before hospitalization(all P<0.05),and the NEUT exacerbation phenotype group had lower FEV1/FVC and was more likely to be complicated by pulmonary heart disease(all P<0.05)compared with the oligocytic exacerbation phenotype.2.Univariate analysis showed that BMI,heart rate,breathing,m MRC dyspnea grade ≥ grade 2,Sa O2,NLR,PLR,FEV1/FVC,FEV1,FVC,pulmonary heart disease,systemic glucocorticoid use cumulative dose,length of hospital stay,number of admissions due to acute exacerbation within 1 year before hospitalization,and NEUT exacerbation phenotype were all risk factors for readmission due to acute exacerbation within 1 year after discharge(all P<0.05).3.The results of multivariate logistic regression analysis showed that after further adjustment of relevant confounding factors,the cumulative dose of FEV1,FVC,complicated pulmonary heart disease,and systemic glucocorticoids were independent risk factors for readmission due to acute exacerbation within one year after discharge of AECOPD patients(all P<0.05).4.ROC curve analysis of peripheral blood EOS%,EOS count,NEUT% and NEUT count on the prediction value of readmission due to acute exacerbation within 1 year after discharge of AECOPD patients,the results showed that the AUC of peripheral blood EOS%,EOS count,NEUT% and NEUT count predicted readmission due to acute exacerbation within 1 year after discharge were 0.346(P<0.05),0.359(P<0.05),0.702(P<0.05)and 0.592(P<0.05),respectively,and further determined that the optimal cut-off values for predicting hospital readmission due to exacerbation within 1 year after discharge were 2.9,0.4,75.1 and 5.3,respectively.5.The evaluation of the predictive value of NLR and PLR for readmission due to acute exacerbation within 1 year after discharge from the hospital in patients with AECOPD showed that the AUC of NLR and PLR for predicting readmission due to acute exacerbation within 1 year after discharge were 0.706(P<0.05)and 0.641(P<0.05),respectively,and the optimal cut-off values for predicting readmission due to exacerbation within 1 year after discharge were 3.2 and 142.6,respectively.Conclusions:1.Compared with patients in the EOS exacerbation phenotype and oligocytic aggravation phenotype,patients in the NEUT exacerbation phenotype group had worse lung function,higher infection indicators,required the use of larger doses of glucocorticoids,were more likely to be complicated by pulmonary heart disease and had a worse prognosis.2.FEV1,FVC,complicated pulmonary heart disease and systemic glucocorticoids are independent risk factors for readmission due to acute exacerbation within 1 year after discharge of AECOPD.3.Peripheral blood NEUT%,NEUT count,NLR and PLR have certain accuracy in predicting hospital readmission due to acute exacerbation within 1 year after discharge,but EOS% and EOS count have no predictive value for hospital readmission due to acute exacerbation within 1 year after discharge.