Prognostic Factors Of Patients With Exacerbation In Asthma-COPD Overlap

BACKGROUND Asthma-COPD overlap(ACO)is a disease which encompass persistent airflow limitation and the characteristics of Asthma and COPD.Its performance is various and its potential pathogenesis is complex.According to previously researches,patients with ACO usually have more severe symptoms,worse daily life ability,poorer quality of life than patients with pure COPD.Moreover,they usually face higher rate of exacerbation and lower survival rate.What's more,the progress of ACO seem to be faster.Not only its symptoms are poorly controlled,but also its lung function decline rapidly.So far,concentrating on the diagnosis and pathogenesis of the ACO,research about prognosis of ACO is still short of.OBJECTIVE 1.Collecting clinical data of exacerbation in patients with ACO,to learn about the characteristic of ACO.2.By following up the patients with ACO,record their numbers of exacerbations or survival state.Analyzing the relationgship between the clinical data and the prognostic imformations got by follow up,we can better understand prognostic factors of exacerbation in asthma–COPD overlap.Which can guide us to manage and cure patients with ACO.METHODS 1.268 patients with AECOPD were recruited during October 2016 to March 2018 in respiratory department of the Third Affiliated Hospital of Guangzhou Medical University.2.The clinical data including general status,medical history,history of allergies,comorbidities,clinical symptoms,inflammation indicators,pulmonary function,the related examinations were collected.3.According to the Consensus on the Asthma-COPD Overlap Syndrome between Ges EPOC and the GEMA,patients were divided into the ACO group and the COPD group.4.We record the numbers of exacerbation and survival status of the patients every two months,during the period of follow up.5.Focusing on the patient's survival status and the number of exacerbations,we using SPSS and STATA to analize the data with t test,Mann–Whitney U test,?2 test and Z test.RESULTS 1.Comparation of clinical data and prognostic factor between ACO and COPD 1.1 General status Comparing to patients with COPD,patients with ACO have higer BMI index(Mean: 23.24±4.56 vs.21.15±3.74,P=0.001),lower age and smoking index(Mean: 547.70±773.09 vs.760.12±709.09,P=0.001).1.2 Imflamatory biomarker Comparing to patients with COPD,patients with ACO have higer EOS count(Mean: 0.34±0.36 vs.0.09±0.09,P<0.001),lower WBC(Mean: 9.14±3.44 vs.10.41±4.79,P=0.016)count,NEU count(Mean: 6.47±3.41 vs.8.46±4.77,P<0.001)and ESR(Mean: 30.93±21.12 vs.40.13±31.98,P=0.008).1.3 Other laboratory data Comparing to patients with COPD,patients with ACO have higer PLT(Mean: 269.54±92.44 vs.243.12±85.96,P=0.027)and ALB(Mean: 37.46±4.27 vs.36.20±4.23,P=0.029),lower BNP-pro(Mean: 835.47±2219.75 vs.1962.24±4225.53,P=0.008).1.4 Prognositic index Patients with ACO have higher risk of exacerbation,RR=11.45,P<0.001.While ACO shows no correlation with death in this research.2.The risk factors of exacerbation in patients with ACO 2.1 General status Patients with higher age have higher risk of exacerbation(RR=1.91,95%CI: 1.29-2.86,P<0.001).Similarly,patients stay longer in hospital increase higher risk of exacerbation(RR=2.66,95%CI:1.76-4.15,P<0.001).While no correlation is showed in risk of exacerbation and factors of BMI index and gender.2.2 m MRC score and comorbidities Patients with OSAHS have lower risk of exacerbation(RR=0.47,95%CI:0.25-0.82,P=0.004).There are no correlation between risk of exacerbation and m MRC score and other comorbidities.2.3 Imflamatory biomarker Patients with higher WBC count have higher risk of exacerbation(RR=1.46,95%CI:1.00-2.13,P=0.040).There are no correlation between risk of exacerbation and other imflamatory biomarker.2.4 Other laboratory data Patients with lower HGB have higher risk of exacerbation(RR=1.53,95%CI:1.04-2.24,P=0.026).There are no correlations between risks of other laboratory data.3.The risk factors of mortality in patients with ACO 3.1 General status,m MRC score and comorbidities There are no correlation between risk of mortality and these three kinds of factor.3.2 Imflamatory biomarker Patients with higher NEU% have higher risk of mortality(RR=6.29,95%CI:1.22-40.52,P=0.0143).Higher PCT may be also a risk factor of death.There are no correlation between risk of mortality and other imflamatory biomarker.3.3 Other laboratory data Patients with higher DDI have higher risk of mortality(RR=12.75,95%CI:1.64-574.91,P=0.004).What's more,patients with lower HGB also have higher risk of mortality(RR=5.29,95%CI:1.03-34.05,P=0.026).There are no correlation between risk of mortality and other laboratory data.CONCLUSION 1.Comparing with patients with COPD,patients with ACO have higher BMI index,PLT,EOS,ALB.On the countrary,they have lower age,smoking index,WBC,NEU,ESR,BNP-pro than patients with COPD.What's more,patients with ACO show higher risk of exacerbation,but no correlation show between ACO and risk of mortality.2.Higher age,longer stay in hospital,higher WBC and lower HGB are risk factors of exacerbation in patients with ACO.3.Higher NEU%,PCT,DDI and lower HGB are risk factors of mortality in patients with ACO.