Analysis Of Risk Factors In Patients With Frequent Acute Exacerbations Of Chronic Obstructive Pulmonary Disease

Objectives: This study seeks to evaluate the risk factors in patients with frequent acute COPD exacerbations by comparing clinical and test data between patients with frequent acute exacerbations and those with rare obstructive pulmonary exacerbations.to offer a theoretical foundation for early detection of individuals with chronic obstructive pulmonary disease（COPD）in clinical work.Methods: This is a retrospective study including patients with an acute exacerbation of COPD diagnosed and treated in the hospital ward of The Second Affiliated Hospital of Kunming Medical University from January 2020 to December2021 and eligible for inclusion in the study.Hospital admissions due to an acute exacerbation of COPD ≥2 times in less than 1 year were defined as frequent acute exacerbations plus recombinations,with a total of 95 cases.An acute exacerbations<2 time was defined as a non-frequent acute period plus recombination,a total of 109 cases.The electronic medical record system was used to collect demographic information and relevant examination and test information for enrolled patients,and baseline data and relevant review of patients in both groups were collected.These variables included age,gender,height,weight,smoking history,disease course,comorbidities,BMI,CAT score,m MRC score,lung function,blood gas analysis,blood cell analysis,acute infection,markers of myocardial injury,and biochemical indicators,and were included in the analysis.The clinical and laboratory data of the two groups were compared,and the indicators with significant differences between the two groups were incorporated into the binary Logistic regression model to analyze the risk factors of frequent acute exacerbations of COPD.A receiver operating characteristic（ROC）curve was plotted,and the area under the curve（AUC）was calculated in order to assess the predictive value of each indicator for the occurrence of frequent acute COPD exacerbations.Results:1.A total of 204 patients were included in this study,including 95 patients with frequent COPD acute plus recombination and 109 patients with non-frequent COPD acute plus recombination.BMI,type II respiratory insufficiency,CAT score,and m MRC score were significantly different between the 2 groups（P < 0.05）.Age,gender,smoking history,course of COPD,coronary artery disease,hypertension,diabetes,type I respiratory failure,heart failure,and pulmonary malignancy were not significantly different between the 2 groups（P > 0.05）.2.In the comparison of laboratory indicators,there were statistically significant differences in FEV1,FEV1%pred,PH,PCO₂,NEUT,LYMPH,NLR and hs-CRP among patients with frequent acute plus recombination and patients without frequent acute plus recombination（P < 0.05）.The biochemical indices of FVC,FEV1/FVC%,MEF25,MEF50,MEF75,MMEF75/25,PEF,PO₂,HCO₃^-,BE,WBC,Hb,PLT,EOS,RDW-CV,RDW-SD,CK-MB,hs-TNT,NT-pro BNP were determined between the two groups There was no significant difference（P > 0.05）There were no significant differences in the biochemical indices of the two groups.3.Bivariate Logisitic regression analysis demonstrated that m MRC score,PCO₂,NLR,and hs-CRP were risk factors for the development of frequent acute exacerbations of COPD.4.Analysis of the ROC curve showed that: The AUC values predicted by the m MRC score,PCO₂,hs-CRP,and NLR alone were 0.643,0.650,0.627,and 0.723,respectively,and the optimal values for the diagnosis were 2.5,42.4,9.12,and 3.59,respectively.The sensitivity and specificity were 33.7% and 88.1%,55.8% and 77.1%,74.7% and 48.6%,83.2% and 50.5%,respectively.Combined m MRC and PCO₂,m MRC and NLR,m MRC and hs-CRP,PCO₂ and NLR,PCO₂ and hs-CRP,and NLR and hs-CRP predicted that the AUC values of patients with frequent COPD acute exacerbations were 0.689,0.728,0.688,0.718,0.673 and 0.72,respectively 1,the optimal critical values were-0.15,-0.45,-0.17,-0.16,-0.10 and-0.46,and the sensitivity and specificity were 61.1% and 68.8%,77.9% and 58.7%,57.9% and74.3%,62.1% and 74.3%,55.8%和 74.3%、82.1% and 54.1%,respectively.The AUC values predicted by 3 combined PCO₂-hs CRP-NLR,hs CRP-NLR-m MRC,m MRC-PCO₂-hs CRP and m MRC-PCO₂-NLR were 0.726,0.734,0.710 and 0.731,respectively,in patients with frequent COPD acute exacerbation.The best diagnostic values were-0.37,-0.44,0.44,-0.04,and the sensitivity and specificity were 72.6%and 65.1%,76.8% and 61.5%,40.0% and 91.7%,61.1% and 79.8%,respectively.The AUC value of the four combined predictors was 0.744,the best diagnosis value was0.17,the sensitivity was 51.6%,and the specificity was 88.1%.The four combined items achieved the best predictive value and the largest AUC area,but the single NLR item and the three combined items（hs CRP-NLR-m MRC,m MRC-PCO₂-NLR）all achieved the same predictive value of the four combined items and had similar AUC area.Conclusions:1.The m MRC score,PCO₂,NLR,and hs CRP are risk factors for frequent acute exacerbations in COPD patients.2.The combined prediction of the four items achieved the maximum AUC area,with good sensitivity and specificity,but high cost.The value of NLR single item is similar to that of the four combined items.The value of NLR single item is the best and the cost is the lowest.The three combined forecasts（hs CRP-NLR-m MRC and m MRC-PCO₂-NLR）all achieved the same prediction value as the four combined forecasts,and had similar AUC areas.