The Value Of Serum Uric Acid And Ratio Of Uric Acid To Creatinine In Evaluating Of The Severity Of AECOPD Patients

Objective:By comparing the expression differences of serum uric acid（UA）and uric acid-to-creatinine ratio（UA/Cr）levels in different clinical stages of chronic obstructive pulmonary disease,different clinical grades of acute exacerbation,and whether patients with acute exacerbation were complicated with pulmonary heart disease,To explore the value of the two in predicting the occurrence of acute exacerbation of chronic obstructive pulmonary disease,different clinical grades and patients with pulmonary heart disease,so as to provide a basis for clinical staff to judge the condition.Methods:A total of 120 inpatients（including 88 males and 32 females）in the Department of Respiratory and Critical Care Medicine of Yan’an University Affiliated Hospital due to AECOPD from September 2018 to October 2021 were retrospectively collected.According to the clinical signs of respiratory failure,respiratory frequency（times/min）,the use of auxiliary breathing muscle group,changes in consciousness,hypoxemia,hypercapnia,they were divided into three subgroups:gradeⅠ（42 cases）,gradeⅡ（42 cases）,and gradeⅢ（36 cases）.At the same time,the patients in AECOPD group were divided into pure AECOPD group and AECOPD combined cor pulmonale group according to the presence or absence of pulmonary heart disease;At the same time,60patients with chronic obstructive pulmonary disease（including 43 males and 27 females）who returned to the outpatient clinic during the same period were collected as the stable COPD group.Access the case information through the medical record browser,collect the baseline data such as gender,age,smoking history,height,weight,and pulmonary heart disease.Body mass index（BMI）is calculated from weight and height values;Collect venous blood reporting parameters:neutrophil count（NEU）,lymphocyte count（LYM）,eosinophilic count（EOS）,hemoglobin（HB）,high-sensitive C-reactive protein（HS-CRP）,serum uric acid,creatinine,indirect bilirubin（IBIL）;Collect arterial blood gas analysis parameters:Arterial partial pressure of oxygen（Pa O₂）,arterial partial pressure of carbon dioxide（Pa CO₂）.Statistical analysis of the collected data:1.The independent sample Mann-Whitney U test was used to describe the change levels of UA,UA/Cr,NLR and other variables in the AECOPD group and COPD group;2.The Kruscal-Wallis H test was used to describe the changes of UA,UA/Cr,NLR equivalents among the three subgroups of AECOPD patients;3.Spearman rank correlation was used to describe the correlation between UA,UA/Cr and clinical grade,NLR,Pa O₂ and Pa CO₂;4.Binary logistic regression was used to analyze whether blood gender,age,smoking,BMI,UA,UA/Cr,NLR,EOS and other indicators were risk factors for acute exacerbation of COPD.5.Receiver operating characteristics ROC curve analysis UA,UA/Cr,NLR and other indicators independently or jointly to predict the occurrence of AECOPD,compare which indicator has higher value,and calculate the optimal cut-off point of each indicator;6.Mann-Whitney U test was used to analyze the differences of UA,UA/Cr and NLR between pure AECOPD group and AECOPD combined cor pulmonale group.Results:1.The independent sample Mann-Whitney U test showed that the values of UA and UA/Cr in the AECOPD group were higher than those in the stable period（p<0.05）;The Kruscal-Wallish H test was used between the three subgroups,showing that the higher the clinical grade of AECOPD patients,the higher the UA and UA/Cr values（p<0.05）.2.Spearman rank correlation analysis showed that UA was positively correlated with clinical grade,NLR and Pa CO₂（r_s values were 0.377,0.193,0.203,p<0.05）,but had no significant correlation with Pa O₂and Hs-CRP（p>0.05）;UA/Cr was positively correlated with clinical disease grading,NLR,Pa CO₂,hs-CRP（rs values were 0.470,0.244,0.253,0.210,p<0.05）,and negatively correlated with Pa O₂（rs values were-0.326,p<0.05）);3.Binary Logistic regression analysis showed that age,BMI,NLR,UAand UA/Cr could affect the occurrence of AECOPD（all p<0.05）;4.Receiver operating characteristic ROC curve analysis showed:UA was used to predict the acute onset of COPD,and the area under the curve（AUC）was 0.611（P<0.05）.When the cut-off value of the maximum Yoden index was 257.5μmol/L,the sensitivity and specificity were 71%and 53%,respectively;UA/Cr predicted the acute exacerbation of COPD,the area under the curve（AUC）was 0.661（p<0.01）,when the cut-off value of the maximum Youden index was 4.52,the sensitivity was 56%,and the specificity was 80%;The area under the curve of NLR was 0.679（p<0.01）for predicting acute exacerbation of COPD,the cut-off value of the maximum Youden index was 3.17,the sensitivity was48%,and the specificity was 87%;5.Receiver operating characteristic ROC curve analysis showed that UA and UA/Cr combined with NLR were used to predict AECOPD respectively.When UA/Cr combined with NLR,the area under the curve（AUC）was the largest,which was 0.738,corresponding sensitivity was 63%and specificity was 77%;6.Mann-Whitney U test showed that the level of UA in AECOPD combined with cor pulmonale group was higher than that in pure AECOPD group（all p<0.05）.Conclusions:1.The ratio of uric acid and uric acid to creatinine in the AECOPD group was higher than that in the stable group,and with the higher the clinical grade of AECOPD,the ratio of serum uric acid and uric acid to creatinine showed an upward trend;Serum uric acid levels were significantly elevated in patients with pulmonary heart disease.2.UA,UA/Cr and NLR are risk factors for acute exacerbation in COPD patients.3.UA/Cr>4.52 and NLR>3.17 have relatively high accuracy in predicting the risk of acute exacerbation in COPD population.Moreover,blood uric acid and creatinine are routine clinical test items and easy to obtain,providing reference value for early clinical identification of high-risk population and active prevention.