Analysis Of Clinical Characteristics Of Elderly Patients With Chronic Obstructive Pulmonary Hypertension And Pulmonary Embolism

Objective:To explore the risk factors of pulmonary hypertension associated with pulmonary embolism（PE）in the elderly（≥65 years old）with chronic obstructive pulmonary disease（COPD）,in order to provide help for the early identification,accurate examination and timely treatment of elderly patients with COPD complicated with PE.Methods:The elderly patients with acute exacerbation of chronic obstructive pulmonary disease（COPD）complicated with pulmonary hypertension and clinically suspected PE who were admitted to the Beijing Road Medical District of the General Hospital of the Xinjiang Military Region from January 2015 to December 2021 were selected as the study subjects.Through CT pulmonary angiography（CTPA）,according to the Naturalization criteria,50 patients with confirmed PE were classified as the combined embolism group,and 50 patients with excluded PE were classified as the non-embolism group.The clinical symptoms,signs,biomarkers,pulmonary arterial pressure（PAP）,electrocardiogram,chest CT,pulmonary embolism simplified Wells score and pulmonary embolism modified Geneva score of the two groups were retrospectively analyzed and compared,and the risk factors of PE associated with chronic obstructive pulmonary hypertension in the elderly were further analyzed by binary logistic regression analysis.To evaluate the predictive value of PAP and D-dimer on the occurrence of PE in elderly patients with chronic obstructive pulmonary hypertension by analyzing the ROC of subjects.The working characteristic curve（ROC）of subjects with the simplified Wells score and the modified Geneva score was prepared,and the area under the curve（AUC）was compared to evaluate the predictive value of the two scores for PE in elderly patients with chronic obstructive pulmonary hypertension.Results:There were statistically significant differences in the following clinical risk factors between the two groups:PAP,D-dimer,C-reactive protein（CRP）,procalcitonin（PCT）,B-type natriuretic peptide（BNP）,simplified Wells score,lung rale,imaging changes（chest CT）,ECG changes,arterial partial oxygen pressure（PaO₂）（P<0.05）.There was no significant difference between the two groups in hemoptysis,chest pain,lower limb edema,modified Geneva score,heart rate,high-sensitivity troponin,and arterial blood partial pressure of carbon dioxide（PaCO₂）（P>0.05）.Binary logistic regression analysis showed that PAP（OR value 1.219,95%CI:1.069-1.389,P<0.05）,D-dimer（OR value 3.179,95%CI:1.277-7.9148,P<0.05）,lung rale（OR value 2.981,95%CI:1.80-6.319,P<0.05）,and imaging abnormalities（OR value 4.679,95%CI:2.564-8.436,P<0.05）were risk factors for pulmonary embolism associated with chronic obstructive pulmonary hypertension in the elderly.The AUC of PAP was 0.866（95%CI:0.797-0.935）,the critical value was 51.5 mm Hg,the sensitivity was 80%,and the specificity was 80%;The AUC of D-dimer is 0.900（95%CI:0.834-0.965）,the critical value is 1.065mg/L,the sensitivity is 88%,and the specificity is88%;It has good predictive value for PE associated with chronic obstructive pulmonary hypertension in the elderly.The AUC of the simplified Wells score was 0.650（95%CI:0.542-0.758）,sensitivity 32%,specificity 92%,positive predictive value 94.1%,negative predictive value 59.0%;The AUC of the modified Geneva score was 0.540（95%CI:0.427-0.653）,sensitivity 38%,specificity 70%,positive predictive value 55.9%,negative predictive value 53.0%.The predictive value of simplified Wells score and modified Geneva score for PE associated with chronic obstructive pulmonary hypertension in the elderly is not high;There was no significant difference between the two scores（P>0.05）.Conclusion:（1）PAP,D-dimer,CRP,PCT,BNP,simplified Wells scores increase,PaO2decreases,lung rales,chest imaging abnormalities,electrocardiogram abnormalities,especially PAP≥51.5mm Hg,D-dimer≥1.065mg/L,lung rales,chest imaging abnormalities,are important clues for the diagnosis of PE in elderly patients with chronic obstructive pulmonary arterial hypertension.CTPA examination should be performed as soon as possible to clarify PAP and D-dimer have good predictive value for PE in elderly patients with chronic obstructive pulmonary hypertension,and the higher the value,the greater the possibility of PE;Individuals with abnormally high pulmonary artery pressure should be vigilant for accompanying PE The predictive value of simplified Wells score and improved Geneva score for PE in elderly patients with chronic obstructive pulmonary hypertension is not high,and there is no significant difference in the scoring effect between the two groups.