The Value Of Blood Biomarkers For Assessment Of Clinical Prognosis In Pulmonary Hypertension Patients Induced By COPD

Objective: To investigate the value of red cell distribution width(RDW)and neutrophil/lymphocyte ratio(NLR)for assessment of the disease severity and clinical prognosis in pulmonary hypertension patients induced by Chronic Obstructive Pulmonary Disease(COPD).Methods: A prospective study was conducted in Xinhua hospital affiliated to Shanghai jiaotong university school of medicine.The pulmonary hypertension patients induced by COPD enrolled in the emergency department were selected as the research subjects from 2012.12 to 2014.03.The clinical data were recorded in 24 h after admission,so as well as laboratory results and imaging information.All patients were followed up until the endpoint of all-cause death,the deadline was 2016.03.According to survival situation,the patients were divided into survival group and death group.The baseline data were compared between the two groups.Correlation analysis were carried out on NLR、RDW and other biomarkers such as World Health Organization Functional Classification(WHO-FC)and pulmonary artery systolic pressure(PASP).Receiver-operating characteristic curve(ROC)was plotted for evaluating the value of blood biomarkers on predicting the clinical prognosis.The clinical indexes were compared between two groups with different levels of RDW and NLR.Kaplan-Meier survival curve and Cox regression analysis were drawn to analyze the survival outcomes.Results: A total of 203 pulmonary hypertension patients induced by COPD were taken into the study,among which 89 were males and 114 were females with a mean age of 77.8±8.2 years old.There were 129 examples in the survival group with an average age of 76.2±8.6 years old and 74 examples in the death group with an average age of 80.7±6.6 years old.The age、neutrophil/lymphocyte ratio(NLR)、red cell distribution width(RDW)、World Health Organization Functional Classification(WHO-FC)、pulmonary arterial systolic pressure(PASP)、left ventricular ejection fraction(LVEF)、neutrophil count、white blood cell count(WBC),C-reactive protein(CRP)、troponin T、Brain Natriuretic Peptide(BNP)、creatinine(Cr)、Blood urea nitrogen(Bun)、Uric Acid(UA)in the death group were significantly higher than those in the survival group,the Haemoglobin(Hb)、lymphocyte count、Hematocrit(HCT)were significantly lower than those in the survival group(P<0.01).Correlation analysis suggests that RDW and NLR were positively correlated with WHO-FC、PASP、BNP、Bun、Cr and UA(P < 0.01).It was shown by ROC curve that the maximum area under the ROC curve(AUC)of RDW was 0.792(P<0.01,95%CI [0.568-0.736]).When the cutt-off value of RDW was 14.0%,the sensitivity was 77.3%,and the specificity was 66.9%.The maximum area under the ROC curve(AUC)of NLR was 0.720(P<0.01,95%CI [0.641-0.799]).When the cutt-off value of NLR was 4.7,the sensitivity was 74.2%,and the specificity was 72.0%.the higher level RDW group(RDW>14.0%)have a relatively higher level of WHO functional class、PASP、BNP、Bun and Cr,and a lower level of survival rate,indicating more serious conditions and prognosis.the higher level NLR group(NLR>4.7)have a relatively higher level of WHO functional class、PASP、BNP、Bun and Cr,and a lower level of survival rate,indicating more serious conditions and prognosis.The Kaplan-Meier survival curve showed that the prognosis in the group with higher levels of RDW was worse than the group with lower levels(log-rank test,P<0.01)and the prognosis in the group with higher levels of NLR was worse than the group with lower levels(log-rank test,P<0.01)as well.Multi-Cox regression analysis suggested that RDW was an independent risk factor for death in PH patients induced by COPD.Conclusions: The blood level of RDW and NLR are significantly correlated with the severity and prognosis in the pulmonary hypertension patient induced by COPD.Higher levels of RDW and NLR may indicate more serious illness and poorer prognosis,a higher level of RDW is also an independent risk factor for adverse event.RDW and NLR have certain value for assessment of the disease severity and clinical prognosis in pulmonary hypertension patients induced by COPD.