Risk Factors Of Pulmonary Thromboembolism In Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Objective: With the emphasis on the complications of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and the improvement of the diagnosis and treatment of pulmonary thromboembolism(PTE),the diagnosis rate of AECOPD combined with PTE has been continuously improved.However,the clinical manifestations of PTE and AECOPD are very similar,resulting in a high rate of missed diagnosis and misdiagnosis of PTE,which brings great troubles to clinical diagnosis and treatment.This study analyzed the risk factors of AECOPD combined with PTE to improve its diagnostic awareness,get a better prognosis and further reduce the mortality of patients.Methods: From January 2011 to March 2022,a total of 255 patients with AECOPD were admitted to the Department of Respiratory and underwent CT pulmonary angiography(CTPA)in the First Affiliated Hospital of Dalian Medical University.These patients met the inclusion criteria of this study.Among them,87 patients with PTE were clearly diagnosed as AECOPD combined with PTE group,a total of 168 patients who were not diagnosed with PTE were selected as the simple AECOPD group.The general data,past history,combined basic diseases,laboratory tests and other related clinical data of the two groups were retrospectively analyzed and compared.The data collected in this study were statistically analyzed and sorted by statistical software SPSS25.0 to explore the diagnosis indicators that can predict AECOPD combined with PTE.Results:1.A total of 255 patients were included in this study,including 147 males(57.6%)and 108 females(42.4 %).There were 87 patients in the AECOPD combined with PTE group,including 47 males(54.0 %)and 40 females(46.0 %),with an average age of 78(71,84)years.There were 168 patients in the AECOPD group,including 100 males(59.5 %)and 68 females(40.5 %),with an average age of 78(70,84.75)years.There was no significant difference in age and sex between the two groups(P > 0.05).2.There were 28 cases(32.2 %)of deep venous thrombosis in the AECOPD combined with PTE group and 9 cases(5.4 %)in the simple AECOPD group.The difference between the two groups was statistically significant(P = 0.000).There was no significant difference in varicose veins,hypertension,coronary heart disease,diabetes,arrhythmia,cerebrovascular disease,malignant tumor and pulmonary hypertension between the two groups(P > 0.05).3.Comparing the test data of the two groups,the levels of D-dimer and D-D / FIB in the AECOPD combined with PTE group were higher than those in the simple AECOPD group,and the Pa O2 level was lower than that in the simple AECOPD group,the difference was statistically significant(P <0.05).There was no significant difference in neutrophil percentage,monocyte percentage,lymphocyte percentage,white blood cell count,platelet count,hematocrit(Hct),hemoglobin,fibrinogen(FIB),neutrophil / lymphocyte ratio(NLR),platelet / lymphocyte ratio(PLR),large platelet-lymphocyte ratio,lymphocyte / monocyte ratio(LMR),monocyte-large platelet ratio(MLPR)between groups(P > 0.05).4.Multi-factor Logistic regression analysis showed that elevated D-dimer,decreased Pa O2,and deep vein thrombosis were independent risk factors for AECOPD with PTE.5.ROC curve analysis of D-dimer and Pa O2 with statistical differences showed that the best cut-off value of D-dimer was 2.56 ug / ml,AUC was 0.662(95 % CI : 0.588 ~ 0.736,P < 0.001),sensitivity was 54 %,specificity was 79.2 %.The optimal cutoff value of Pa O2 was 74.5 mm Hg,AUC was 0.65(95 % CI : 0.578-0.722,P < 0.001),sensitivity was 54.2 %,and specificity was 72.4 %.Conclusion:1.The history of deep vein thrombosis,elevated D-dimer,and decreased Pa O2 are important predictors of AECOPD patients with PTE.Early screening and early detection of PTE are of great significance for reducing missed diagnosis and misdiagnosis.2.When D-dimer ≥ 2.56 ug / ml,it is highly suggestive of AECOPD combined with PTE,with a sensitivity of 54 % and a specificity of 79.2 %.When Pa O2 ≤ 74.5 mm Hg,it is highly suggestive of AECOPD combined with PTE,with a sensitivity of 54.2 % and a specificity of 72.4 %.3.The increase of D-D / FIB ratio is also a good predictor of AECOPD combined with PTE.